Compositions comprising natriuretic peptides and methods of use thereof

ABSTRACT

The present invention provides methods, compositions, and kits for the treatment of disorders associated with overactivation of FGFR3, such as achondroplasia; bone or cartilage disorders; or vascular smooth muscle disorders, or for the elongation of bone. In some embodiments, the present invention provides polypeptides having a natriuretic peptide fused to an Fc domain of an immunoglobulin. Such polypeptides can be administered to subjects, e.g., subcutaneously, to treat a disorder associated with overactivation of FGFR3, a bone or cartilage disorder, or a vascular smooth muscle disorder, or to elongate bone. The invention also features nucleic acid molecules encoding such polypeptides and the use of the nucleic acid molecules for treating disorders associated with overactivation of FGFR3, bone or cartilage disorders, or vascular smooth muscle disorders, or for elongating bone.

CROSS REFERENCE TO RELATED APPLICATIONS

This application claims the benefit of the filing date of U.S. Provisional Patent Application No. 61/427,365, filed Dec. 27, 2010, and U.S. Provisional Patent Application No. 61/524,155, filed Aug. 16, 2011, each of which is incorporated herein by reference.

REFERENCE TO A SEQUENCE LISTING

A Sequence Listing is provided in this patent document as a .txt file entitled, “50694012003_ST25_Seq_Listing.txt,” created Dec. 23, 2011 (file size 555 kB). The content of this file is hereby incorporated by reference.

BACKGROUND OF THE INVENTION

Natriuretic peptides modulate salt and water homeostasis in the body and in this way act as regulators of blood pressure. The peptides belonging to this family have varying amino acid sequences and are secreted through different mechanisms by various tissues in the body. These peptides include atrial natriuretic peptide (ANP), brain natriuretic peptide (BNP), and C-type natriuretic peptide (CNP). These peptides bind to three types of receptors that signal intracellularly to modulate physiological functions. ANP and BNP bind preferentially to natriuretic peptide receptor A (NPR-A) (also known as guanylyl cyclase A (GC-A)), and CNP binds preferentially to natriuretic peptide receptor (NPR-B) (also known as guanylyl cyclase B (GC-B)). All three peptides have similar affinity for natriuretic peptide receptor C(NPR-C), which has both signaling and peptide clearance functions. Clearance of natriuretic peptides also occurs through the action of membrane-bound neutral endopeptidase (NEP).

Peptide binding to NPR-A or NPR-B activates the intracellular guanylyl cyclase domain of these receptors, which produces the second messenger cGMP. cGMP activates or inhibits multiple signaling pathways inside the cell.

Bone formation and longitudinal bone growth in long bones, ribs, and vertebrae occurs via endochondral ossification in the cartilaginous growth plate, which is located at both ends of the bone. One important regulator of bone growth is CNP, which circulates in blood at a very low level, suggesting that it has very little systemic activity on bone. Studies using primary cultures of osteoblast-like cells and chondrocytes have revealed that CNP acts rather as a paracrine/autocrine factor to regulate proliferation and differentiation of osteoblasts and chondrocytes. CNP, through activation of NPR-B guanylyl cyclase, stimulates the production of intracellular messenger cGMP in chondrocytes and is important for bone growth and development.

In humans, CNP is initially produced from the natriuretic peptide precursor C(NPPC) gene as a single chain 126-amino acid pre-pro polypeptide. Removal of the signal peptide yields pro-CNP, and further cleavage by the endoprotease furin generates an active 53-amino acid peptide (CNP53), which is secreted and cleaved again by an unknown enzyme to produce the mature 22-amino acid peptide (CNP22). Both CNP53 and CNP22 bind similarly to NPR-B, and they both induce cGMP production in a dose-dependent and similar fashion.

Genetic deletion of CNP, its cognate receptor, or downstream intracellular effector (PKG) results in severe skeletal dysplasias caused by reduced chondrocyte proliferation and differentiation. In mice lacking CNP, dwarfism and early death occur. At birth, these mice have approximately 10% reduction in bone length, but the growth retardation becomes more severe postnatally, and 70% of the mice die in the first 100 days after birth. Cartilage-specific overexpression of CNP partially rescues the achondroplasia dwarfism of the CNP-deficient mice, suggesting that CNP stimulates bone growth through direct effects on chondrocytes. Functional inactivation of the natriuretic peptide (NPR)-B receptor that binds CNP or gene encoding for cGMP protein kinase II through which cGMP effects are mediated also produces dwarfism.

Skeletal dysplasias are a group of genetic disorders characterized by impaired skeletal growth. The many different forms of skeletal dysplasia, e.g., short limb dwarfism, are associated with significant morbidity and mortality. Achondroplasia is the most common form of short limb dwarfism in human beings, affecting more than 250,000 individuals worldwide. Achondroplasia is caused by mutations in the gene encoding fibroblast growth factor receptor 3 (FGFR3), which cause gain of FGFR3 function. These mutations affect many tissues, but most strikingly the cartilaginous growth plate in the growing skeleton, leading to a variety of manifestations and complications. The severity of the clinical phenotype is related to the capacity of the mutation to overactivate FGFR3 signaling pathways in chondrocytes.

The intracellular production of cGMP resulting from NPR-B activation is known to inhibit the MAP-kinase pathway overactivated by the FGFR3 mutation. Thus, use of CNP or a CNP analog that could activate the NPR-B signaling pathway for the treatment of skeletal dysplasia has been considered. However, a major drawback of the therapeutic use of CNP is its extremely short half-life. Furthermore, experiments in the literature, e.g., Farnum et al. (Anat. Rec. A Discov. Mol. Cell Evol. Biol. 288(1):91-103, 2006), have shown that the ability of a molecule to enter the growth plate decreases significantly with molecular weight, with poor or no detectable entry by molecules of 40 kDa or larger into the growth plate. Accordingly, it has been believed that CNP-based therapeutics for skeletal dysplasias such as achondroplasia need to have a relatively small molecular weight in order to be capable of entering the growth plate at a sufficient rate to have a therapeutic effect.

There is thus a need in the art to develop therapeutic molecules having an appreciable half-life and other favorable pharmacokinetic and therapeutic properties for the treatment of a variety of disorders, such as achondroplasia.

SUMMARY OF THE INVENTION

It has surprisingly been discovered that natriuretic peptide-containing polypeptides of the present invention, e.g., including an Fc domain, are therapeutically effective in the treatment of disorders such as achondroplasia.

Accordingly, in a first aspect, the invention features a method of treating a disorder associated with overactivation of FGFR3, a bone or cartilage disorder, or a vascular smooth muscle disorder in a subject, e.g., a human, the method including administering to the subject a therapeutically effective amount of a pharmaceutical composition including: (a) a polypeptide including the structure X-Fc-Y—NP-Z or the structure X—NP—Y-Fc-Z; and (b) a pharmaceutically acceptable excipient, wherein NP is a natriuretic peptide that is an agonist of natriuretic peptide receptor B (NPR-B); and each of X, Y, and Z is, independently, absent or is an amino acid sequence of at least one amino acid. In some embodiments, the disorder associated with overactivation of FGFR3, bone or cartilage disorder, or vascular smooth muscle disorder in the subject is thereby treated.

In a second aspect, the invention features a method of elongating bone in a subject, e.g., a human, the method including administering to the subject a therapeutically effective amount of a pharmaceutical composition including: (a) a polypeptide including the structure X-Fc-Y—NP-Z or the structure X—NP—Y-Fc-Z; and (b) a pharmaceutically acceptable excipient, wherein NP is a natriuretic peptide that is an agonist of natriuretic peptide receptor B (NPR-B); and each of X, Y, and Z is, independently, absent or is an amino acid sequence of at least one amino acid.

In some embodiments of the above aspects, the polypeptide includes the structure X-Fc-Y—NP-Z. In some embodiments, the NP includes the structure: [N-terminal extension]-[short segment]-[ring domain]-[C-terminal extension], wherein the ring domain includes the amino acid sequence of SEQ ID NO: 6, amino acids 11-27 of SEQ ID NO: 30, or SEQ ID NO: 95, and each of the N-terminal extension, short segment, and C-terminal extension is, independently, absent or is an amino acid sequence of at least one amino acid. In some embodiments, the ring domain includes amino acids 6-22 of SEQ ID NO: 126. In some embodiments, the amino acid at position 17 of SEQ ID NO: 126 is Phe, Leu, Ile, Thr, Val, Ala, or Ser. In some embodiments, the amino acid at position 17 of SEQ ID NO: 126 is Phe, Leu, Ile, Thr, Glu, Arg, Tyr, Cys, Pro, Asp, Gly, Ala, Ser, Val, Trp, Asn, Gln, His, or Lys, e.g., Phe, Leu, Ile, Thr, Glu, Arg, Tyr, Cys, Pro, or Asp, e.g., Phe or Leu, e.g., Phe, e.g., Leu. In some embodiments, the ring domain includes the amino acid sequence of SEQ ID NO: 12. In some embodiments, the short segment and the ring domain together include the amino acid sequence of any one of SEQ ID NOs: 4 or 13-30. In some embodiments, the amino acid sequence of the short segment consists of amino acids 1-5 of SEQ ID NO: 4. In some embodiments, the amino acid sequence of the short segment consists of amino acids 1-5, 2-5, 3-5, 4-5, or 5 of SEQ ID NO: 4, amino acids 1-10 of SEQ ID NO: 17, amino acids 1-5 of SEQ ID NO: 19, amino acids 1-3 of SEQ ID NO: 20, amino acids 1-5 of SEQ ID NO: 21, or amino acids 1-6 of SEQ ID NO: 29. In some embodiments, the amino acid sequence of the short segment and the ring domain together consists of the amino acid sequence of SEQ ID NO: 4. In some embodiments, the amino acid sequence of the short segment and the ring domain together consists of the amino acid sequence of any one of SEQ ID NOs: 119-122, 126, or 156-161 (e.g., where X in SEQ ID NO: 126 is Phe, Leu, Ile, Thr, Glu, Arg, Tyr, Cys, Pro, Asp, Gly, Ala, Ser, Val, Trp, Asn, Gln, His, or Lys, e.g., Phe, Leu, Ile, Thr, Glu, Arg, Tyr, Cys, Pro, or Asp, e.g., Phe or Leu, e.g., Phe, e.g., Leu). In some embodiments, the amino acid sequence of the N-terminal extension includes amino acids 1-31 of SEQ ID NO: 11. In some embodiments, the amino acid sequence of the N-terminal extension includes amino acids 17-31 of SEQ ID NO: 11. In some embodiments, the amino acid sequence of the N-terminal extension includes KGANKK (SEQ ID NO: 314) or KGANQK (SEQ ID NO: 315). In some embodiments, the N-terminal extension, short segment, and ring domain together include the amino acid sequence of SEQ ID NO: 11. In some embodiments, the C-terminal extension includes the amino acid sequence of SEQ ID NO: 118, SEQ ID NO: 117, or amino acids 23-37 selected from any one of SEQ ID NOs: 101-116. In some embodiments, the amino acid sequence of the NP consists of SEQ ID NO: 4. In some embodiments, the amino acid sequence of the NP consists of SEQ ID NO: 11. In some embodiments, the amino acid sequence of the NP consists of the amino acid sequence of any one of SEQ ID NOs: 31-94, or a fragment thereof including at least a ring domain.

In any of the aspects described herein, the amino acid sequence of the NP includes amino acids 6-22 of SEQ ID NO: 126, and the amino acid at position 17 of SEQ ID NO: 126 is Phe.

In any of the aspects described herein, the amino acid sequence of the NP includes amino acids 6-22 of SEQ ID NO: 126, and the amino acid at position 17 of SEQ ID NO: 126 is Leu.

In of the aspects described herein, the amino acid sequence of the NP includes amino acids 6-22 of SEQ ID NO: 126, and the amino acid at position 17 of SEQ ID NO: 126 is Ile.

In any of the aspects described herein, the amino acid sequence of the NP includes amino acids 6-22 of SEQ ID NO: 126, and the amino acid at position 17 of SEQ ID NO: 126 is Thr.

In any of the aspects described herein, the amino acid sequence of the NP includes amino acids 6-22 of SEQ ID NO: 126, and the amino acid at position 17 of SEQ ID NO: 126 is Glu.

In any of the aspects described herein, the amino acid sequence of the NP includes amino acids 6-22 of SEQ ID NO: 126, and the amino acid at position 17 of SEQ ID NO: 126 is Arg.

In any of the aspects described herein, the amino acid sequence of the NP includes amino acids 6-22 of SEQ ID NO: 126, and the amino acid at position 17 of SEQ ID NO: 126 is Tyr.

In any of the aspects described herein, the amino acid sequence of the NP includes amino acids 6-22 of SEQ ID NO: 126, and the amino acid at position 17 of SEQ ID NO: 126 is Cys.

In any of the aspects described herein, the amino acid sequence of the NP includes amino acids 6-22 of SEQ ID NO: 126, and the amino acid at position 17 of SEQ ID NO: 126 is Pro.

In any of the aspects described herein, the amino acid sequence of the NP includes amino acids 6-22 of SEQ ID NO: 126, and the amino acid at position 17 of SEQ ID NO: 126 is Asp.

In any of the aspects described herein, the amino acid sequence of the NP includes amino acids 6-22 of SEQ ID NO: 126, and the amino acid at position 17 of SEQ ID NO: 126 is Gly.

In any of the aspects described herein, the amino acid sequence of the NP includes amino acids 6-22 of SEQ ID NO: 126, and the amino acid at position 17 of SEQ ID NO: 126 is Ala.

In any of the aspects described herein, the amino acid sequence of the NP includes amino acids 6-22 of SEQ ID NO: 126, and the amino acid at position 17 of SEQ ID NO: 126 is Ser.

In any of the aspects described herein, the amino acid sequence of the NP includes amino acids 6-22 of SEQ ID NO: 126, and the amino acid at position 17 of SEQ ID NO: 126 is Val.

In any of the aspects described herein, the amino acid sequence of the NP includes amino acids 6-22 of SEQ ID NO: 126, and the amino acid at position 17 of SEQ ID NO: 126 is Trp.

In any of the aspects described herein, the amino acid sequence of the NP includes amino acids 6-22 of SEQ ID NO: 126, and the amino acid at position 17 of SEQ ID NO: 126 is Asn.

In any of the aspects described herein, the amino acid sequence of the NP includes amino acids 6-22 of SEQ ID NO: 126, and the amino acid at position 17 of SEQ ID NO: 126 is Gln.

In any of the aspects described herein, the amino acid sequence of the NP includes amino acids 6-22 of SEQ ID NO: 126, and the amino acid at position 17 of SEQ ID NO: 126 is His.

In any of the aspects described herein, the amino acid sequence of the NP includes amino acids 6-22 of SEQ ID NO: 126, and the amino acid at position 17 of SEQ ID NO: 126 is Lys.

In some embodiments, the amino acid sequence of the NP consists of the amino acid sequence of any one of SEQ ID NOs: 13-29, 100-116, 119-125, 127-233, or 1001-1155.

In some embodiments, the NP is selective for NPR-B over NPR-A, wherein the EC_(50(NPR-A))/EC_(50(NPR-B)) ratio for the NP, as determined in an in vivo pharmacokinetic assay, is at least 30.

In some embodiments, the Fc includes a C_(H2) domain, a C_(H3) domain, and a hinge region. In some embodiments, the Fc is a constant domain of an immunoglobulin selected from the group consisting of IgG-1, IgG-2, IgG-3, IgG-3 and IgG-4. In some embodiments, the Fc includes the amino acid sequence of SEQ ID NO: 401. In some embodiments, the immunoglobulin is IgG-1. In some embodiments, the amino acid sequence of the Fc includes an amino acid sequence having at least 80%, 85%, 90%, 95%, or 99% sequence identity to SEQ ID NO: 401, or includes or consists of the amino acid sequence of SEQ ID NO: 401.

In some embodiments, Y includes a glycine-rich region, or the amino acid sequence of Y consists of one or more glycines and one or more serines. For example, the amino acid sequence of Y may include [(Gly)_(m)(Ser)]_(n)(Gly)_(p) or (Gly)_(p)[(Ser)(Gly)_(m)]_(n), wherein each of m, n, and p is, independently, between 0 and 20. In some embodiments, m is between 1 and 6; n is between 1 and 10; and p is between 0 and 4. In some embodiments, m is 4 and n is 1-6. In some embodiments, combinations of m, n, and p are selected from a single row of Table 1, or the amino acid sequence of Y includes the amino acid sequence of any one of SEQ ID NOs: 301-389. In some embodiments, the amino acid sequence of Y consists of [(Gly)_(m)(Ser)]_(n)(Gly)_(p) or (Gly)_(p)[(Ser)(Gly)_(m)]_(n), wherein combinations of m, n, and p are selected from a single row of Table 1, or the amino acid sequence of Y consists of the amino acid sequence of any one of SEQ ID NOs: 301-389.

In some embodiments, X is absent, Z is absent, or X and Z are both absent.

In some embodiments, X, Y, or Z includes a bone-targeting moiety, e.g., including 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, or 16 consecutive acidic residues, e.g., aspartic acid or glutamic acid. In some embodiments, the bone-targeting moiety includes or consists of E₆, E₇, E₈, E₉, E₁₀, E₁₁, E₁₂, E₁₃, E₁₄, E₁₅, E₁₆, D₆, D₇, D₈, D₉, D₁₀, D₁₁, D₁₂, D₁₃, D₁₄, D₁₅, or D₁₆, e.g., E₆, E₁₀, D₆, or D₁₀.

In some embodiments, X, Y, or Z includes a cathepsin (e.g., cathepsin K) cleavage sequence. In some embodiments, the cathepsin cleavage sequence includes or consists of HGPQG (SEQ ID NO: 374) or HKLRG (SEQ ID NO: 375).

In some embodiments, the polypeptide includes or consists of the amino acid sequence of any one of SEQ ID NOs: 501-608, e.g., SEQ ID NO: 502, SEQ ID NO: 504, SEQ ID NO: 506, SEQ ID NO: 512, SEQ ID NO: 514, SEQ ID NO: 516, SEQ ID NO: 560, SEQ ID NO: 562, SEQ ID NO: 564, SEQ ID NO: 572, SEQ ID NO: 574, SEQ ID NO: 576, SEQ ID NO: 584, SEQ ID NO: 586, SEQ ID NO: 588, SEQ ID NO: 596, SEQ ID NO: 598, SEQ ID NO: 600, or SEQ ID NO: 608. In some embodiments, the polypeptide includes a bone-targeting moiety, e.g., E₆, E₇, E₈, E₉, E₁₀, E₁₁, E₁₂, E₁₃, E₁₄, E₁₅, E₁₆, D₆, D₇, D₈, D₉, D₁₀, D₁₁, D₁₂, D₁₃, D₁₄, D₁₅, or D₁₆, e.g., E₆, E₁₀, D₆, or D₁₀.

In some embodiments, the polypeptide includes or consists of the amino acid sequence of SEQ ID NO: 512.

In some embodiments, the polypeptide includes or consists of the amino acid sequence of SEQ ID NO: 554.

In some embodiments, the polypeptide includes or consists of the amino acid sequence of SEQ ID NO: 572.

In some embodiments, the polypeptide includes or consists of the amino acid sequence of SEQ ID NO: 578.

In a third aspect, the invention features a method of treating a disorder associated with overactivation of FGFR3, a bone or cartilage disorder, or a vascular smooth muscle disorder in a subject, e.g., a human, the method including administering to the subject a therapeutically effective amount of a pharmaceutical composition including: (a) a polypeptide including the structure V-NP-W; and (b) a pharmaceutically acceptable excipient, wherein NP is a natriuretic peptide that is an agonist of natriuretic peptide receptor B (NPR-B); each of V and W is, independently, absent or is an amino acid sequence of at least one amino acid; and the NP includes the amino acid sequence of any one of SEQ ID NOs: 17-29, 31-40, 42-94, 101-116, 119-122, 128-161, or 163-233, or V or W includes the amino acid sequence of any one of SEQ ID NOs: 304-313, 322-333, or 337-389. In some embodiments, the disorder associated with overactivation of FGFR3, bone or cartilage disorder, or vascular smooth muscle disorder in the subject is thereby treated.

In a fourth aspect, the invention features a method of elongating bone in a subject, e.g., a human, the method including administering to the subject a therapeutically effective amount of a pharmaceutical composition including: (a) a polypeptide including the structure V-NP-W; and (b) a pharmaceutically acceptable excipient, wherein NP is a natriuretic peptide that is an agonist of natriuretic peptide receptor B (NPR-B); each of V and W is, independently, absent or is an amino acid sequence of at least one amino acid; and the NP includes the amino acid sequence of any one of SEQ ID NOs: 17-29, 31-40, 42-94, 101-116, 119-122, 128-161, or 163-233, or V or W includes the amino acid sequence of any one of SEQ ID NOs: 304-313, 322-333, or 337-389.

In some embodiments of the third and fourth aspects, any of the NPs or polypeptides described herein may be used in conjunction with the method (e.g., NPs or polypeptides described in some embodiments of the first and second aspects). In some embodiments, the amino acid sequence of V or W includes [(Gly)_(m)(Ser)]_(n)(Gly)_(p) or (Gly)_(p)[(Ser)(Gly)_(m)]_(n), wherein each of m, n, and p is, independently, between 0 and 20. In some embodiments, in is 4 and n is 1-6. In some embodiments, V is absent, W is absent, or V and W are both absent. In some embodiments, V or W includes a bone-targeting moiety, e.g., E₆, E₇, E₈, E₉, E₁₀, E₁₁, E₁₂, E₁₃, E₁₄, E₁₅, E₁₆, D₆, D₇, D₈, D₉, D₁₀, D₁₁, D₁₂, D₁₃, D₁₄, D₁₅, or D₁₆, e.g., E₆, E₁₀, D₆, or D₁₀. In some embodiments, V or W includes a cathepsin (e.g., cathepsin K) cleavage sequence, e.g., HGPQG (SEQ ID NO: 374) or HKLRG (SEQ ID NO: 375).

In a fifth aspect, the invention features a method of treating a disorder associated with overactivation of FGFR3, a bone or cartilage disorder, or a vascular smooth muscle disorder in a subject, e.g., a human, the method including administering to the subject a therapeutically effective amount of a pharmaceutical composition including: (a) a polypeptide including the structure V-NP or NP-W; and (b) a pharmaceutically acceptable excipient, wherein NP is a natriuretic peptide that is an agonist of natriuretic peptide receptor B (NPR-B); and each of V and W includes, independently, the amino acid sequence of any one of SEQ ID NOs: 304-313, 322-333, or 337-389. In some embodiments, the disorder associated with overactivation of FGFR3, bone or cartilage disorder, or vascular smooth muscle disorder in the subject is thereby treated.

In a sixth aspect, the invention features a method of elongating bone in a subject, e.g., a human, the method including administering to the subject a therapeutically effective amount of a pharmaceutical composition including: (a) a polypeptide including the structure V-NP or NP-W; and (b) a pharmaceutically acceptable excipient, wherein NP is a natriuretic peptide that is an agonist of natriuretic peptide receptor B (NPR-B); and each of V and W includes, independently, the amino acid sequence of any one of SEQ ID NOs: 304-313, 322-333, or 337-389.

In some embodiments of the fifth and sixth aspects, any of the NPs or polypeptides described herein may be used in conjunction with the method (e.g., NPs or polypeptides described in some embodiments of the first and second aspects). In some embodiments, the polypeptide includes the structure V-NP. In some embodiments, the amino acid sequence of V or W includes [(Gly)_(m)(Ser)]_(n)(Gly)_(p) or (Gly)_(p)[(Ser)(Gly)_(m)]_(n), wherein each of m, n, and p is, independently, between 0 and 20. In some embodiments, m is 4 and n is 1-6. In some embodiments, V or W includes a bone-targeting moiety, e.g., E₆, E₇, E₈, E₉, E₁₀, E₁₁, E₁₂, E₁₃, E₁₄, E₁₅, E₁₆, D₆, D₇, D₈, D₉, D₁₀, D₁₁, D₁₂, D₁₃, D₁₄, D₁₅, or D₁₆, e.g., E₆, E₁₀, D₆, or D₁₀. In some embodiments, V or W includes a cathepsin (e.g., cathepsin K) cleavage sequence, e.g., HGPQG (SEQ ID NO: 374) or HKLRG (SEQ ID NO: 375).

In some embodiments of any of the methods described herein, V or W consists of the amino acid sequence of any one of SEQ ID NOs: 304-313, 322-333, or 337-389.

In some embodiments of any of the methods described herein, the polypeptide is glycosylated or pegylated. In some embodiments, the pharmaceutical composition includes a dimer of the polypeptide. In some embodiments, the pharmaceutically acceptable excipient includes saline. In some embodiments, the pharmaceutical composition is lyophilized. In some embodiments, the pharmaceutical composition is administered subcutaneously, intravenously, orally, nasally, intramuscularly, sublingually, intrathecally, or intradermally.

In some embodiments, the pharmaceutical composition is administered to the subject in a dosage between about 0.5 mg/kg to about 500 mg/kg once, twice, three times, or four times daily. The dosage may be between, e.g., about 5 mg/kg to about 200 mg/kg, e.g., about 10 mg/kg to about 100 mg/kg, once, twice, three times, or four times daily. In some embodiments, the dosage is about 10 mg/kg or about 100 mg/kg twice daily.

In some embodiments, the pharmaceutical composition is administered to the subject in a dosage between about 0.5 mg/kg to about 500 mg/kg once or twice weekly. The dosage may be between, e.g., about 5 mg/kg to about 200 mg/kg, e.g., about 10 mg/kg to about 100 mg/kg, e.g., about 20 mg/kg to about 40 mg/kg, once or twice weekly. In some embodiments, the dosage is about 10 mg/kg, about 30 mg/kg, or about 100 mg/kg, once or twice weekly.

In some embodiments, the pharmaceutical composition is administered to the subject in a dosage between about 10 μg/kg to about 1,000 μg/kg once or twice weekly. The dosage may be between, e.g., about 20 μg/kg to about 800 μg/kg, e.g., about 30 μg/kg to about 600 μg/kg, e.g., about 50 μg/kg to about 500 μg/kg, e.g., about 100 μg/kg to about 400 μg/kg, e.g., about 200 μg/kg to about 300 μg/kg, once or twice weekly. In some embodiments, the dosage is about 30 μg/kg, about 100 μg/kg, about 300 μg/kg, or about 500 μg/kg, once or twice weekly.

In some embodiments, the pharmaceutical composition is administered to the subject between one and fourteen times per week, or is administered at least once daily for at least one month. In preferred embodiments, the pharmaceutical composition is administered to the subject once weekly for at least one month.

In some embodiments of any of the methods described herein, the disorder associated with overactivation of FGFR3 is a bone or cartilage disorder, e.g., a skeletal dysplasia, such as any described herein. In some embodiments of any of the methods described herein, the bone or cartilage disorder is a skeletal dysplasia, e.g., achondroplasia, homozygous achondroplasia, heterozygous achondroplasia, achondrogenesis, acrodysostosis, acromesomelic dysplasia, atelosteogenesis, camptomelic dysplasia, chondrodysplasia punctata, rhizomelic type of chondrodysplasia punctata, cleidocranial dysostosis, congenital short femur, craniosynostosis (e.g., Muenke syndrome, Crouzon syndrome, Apert syndrome, Jackson-Weiss syndrome, Pfeiffer syndrome, or Crouzonodermoskeletal syndrome), dactyl), brachydactyl), camptodactyl), polydactyl), syndactyl), diastrophic dysplasia, dwarfism, dyssegmental dysplasia, enchondromatosis, fibrochondrogenesis, fibrous dysplasia, hereditary multiple exostoses, hypochondroplasia, hypophosphatasia, hypophosphatemic rickets, Jaffe-Lichtenstein syndrome, Kniest dysplasia, Kniest syndrome, Langer-type mesomelic dysplasia, Marfan syndrome, McCune-Albright syndrome, micromelia, metaphyseal dysplasia, Jansen-type metaphyseal dysplasia, metatrophic dysplasia, Morquio syndrome, Nievergelt-type mesomelic dysplasia, neurofibromatosis (e.g., type 1, e.g., with bone manifestations or without bone manifestations; type 2; or schwannomatosis), osteoarthritis, osteochondrodysplasia, osteogenesis imperfecta, perinatal lethal type of osteogenesis imperfecta, osteopetrosis, osteopoikilosis, peripheral dysostosis, Reinhardt syndrome, Roberts syndrome, Robinow syndrome, short-rib polydactyly syndromes, short stature, spondyloepiphyseal dysplasia congenita, spondyloepimetaphyseal dysplasia, or thanatophoric dysplasia. In some embodiments, the pharmaceutical composition is administered in an amount that is therapeutically effective to treat an achondroplasia phenotype selected from the group consisting of growth retardation, skull deformities, and orthodontic defects. In some embodiments, the pharmaceutical composition is administered in an amount that is therapeutically effective to treat an achondroplasia phenotype selected from the group consisting of cervical cord compression, spinal stenosis, hydrocephalus, hearing loss due to chronic otitis, cardiovascular disease, neurological disease, and obesity. In some embodiments of any of the methods described herein, the disorder associated with overactivation of FGFR3 is cancer, e.g., multiple myeloma, myeloproliferative syndrome, leukemia, plasma cell leukemia, lymphoma, glioblastoma, prostate cancer, bladder cancer, or mammary cancer. In some embodiments of any of the methods described herein, the vascular smooth muscle disorder is hypertension, restenosis, arteriosclerosis, acute decompensated heart failure, congestive heart failure, cardiac edema, nephredema, hepatic edema, acute renal insufficiency, or chronic renal insufficiency.

In a seventh aspect, the invention features an isolated polypeptide including the structure X-Fc-Y—NP-Z or the structure X—NP—Y-Fc-Z, wherein NP is a natriuretic peptide that is an agonist of natriuretic peptide receptor B (NPR-B), and wherein either: (i) NP includes amino acids 6-22 of SEQ ID NO: 126, wherein the amino acid at position 17 is not Met; and each of X, Y, and Z is, independently, absent or is an amino acid sequence of at least one amino acid; or (ii) each of X and Z is, independently, absent or is an amino acid sequence of at least one amino acid; and the amino acid sequence of Y includes [(Gly)₄(Ser)]_(n)(Gly)_(p) or (Gly)_(p)[(Ser)(Gly)₄]_(n), wherein n is between 1 and 10 and p is between 0 and 4 or wherein combinations of m, n, and p are selected from a single row of Table 1, or wherein the amino acid sequence of Y includes the amino acid sequence of any one of SEQ ID NOs: 304-313, 322-333, or 337-389.

In some embodiments of the seventh aspect, the polypeptide includes the structure X-Fc-Y—NP-Z.

In some embodiments of the seventh aspect, (i) NP includes amino acids 6-22 of SEQ ID NO: 126, wherein the amino acid at position 17 is not Met; and each of X, Y, and Z is, independently, absent or is an amino acid sequence of at least one amino acid. In some embodiments, the amino acid at position 17 of SEQ ID NO: 126 is Phe, Leu, Ile, Thr, Val, Ala, or Ser. In some embodiments, the amino acid at position 17 of SEQ ID NO: 126 is Phe, Leu, Ile, Thr, Glu, Arg, Tyr, Cys, Pro, Asp, Gly, Ala, Ser, Val, Trp, Asn, Gln, His, or Lys, e.g., Phe, Leu, Ile, Thr, Glu, Arg, Tyr, Cys, Pro, or Asp, e.g., Phe or Leu, e.g., Phe, e.g., Leu. In some embodiments, the NP includes the structure: [N-terminal extension]-[short segment]-[ring domain]-[C-terminal extension], wherein said ring domain comprises amino acids 6-22 of SEQ ID NO: 126, wherein the amino acid at position 17 is not Met, and each of said N-terminal extension, short segment, and C-terminal extension is, independently, absent or is an amino acid sequence of at least one amino acid. In some embodiments, the amino acid sequence of said NP includes or consists of the amino acid sequence of any one of SEQ ID NOs: 119-125 or 156-220, wherein position 17 relative to SEQ ID NO: 126 is not Met, or the amino acid sequence of any one of SEQ ID NOs: 221-233.

In some embodiments of the seventh aspect, (ii) each of X and Z is, independently, absent or is an amino acid sequence of at least one amino acid; and the amino acid sequence of Y comprises [(Gly)₄(Ser)]_(n)(Gly)_(p) or (Gly)_(p)[(Ser)(Gly)₄]_(n), wherein n is between 1 and 10 and p is between 0 and 4, or wherein the amino acid sequence of Y comprises the amino acid sequence of any one of SEQ ID NOs: 304-313, 322-333, or 337-389. In some embodiments, the NP includes the structure: [N-terminal extension]-[short segment]-[ring domain]-[C-terminal extension], wherein the ring domain includes the amino acid sequence of SEQ ID NO: 6, amino acids 11-27 of SEQ ID NO: 30, or SEQ ID NO: 95, and each of the N-terminal extension, short segment, and C-terminal extension is, independently, absent or is an amino acid sequence of at least one amino acid. In some embodiments, the ring domain includes amino acids 6-22 of SEQ ID NO: 126. In some embodiments, the amino acid at position 17 of SEQ ID NO: 126 is Phe, Leu, Ile, Thr, Val, Ala, or Ser. In some embodiments, the amino acid at position 17 of SEQ ID NO: 126 is Phe, Leu, Ile, Thr, Glu, Arg, Tyr, Cys, Pro, Asp, Gly, Ala, Ser, Val, Trp, Asn, Gln, His, or Lys, e.g., Phe, Leu, Ile, Thr, Glu, Arg, Tyr, Cys, Pro, or Asp, e.g., Phe or Leu, e.g., Phe, e.g., Leu. In some embodiments, the ring domain includes the amino acid sequence of SEQ ID NO: 12. In some embodiments, the short segment and the ring domain together include the amino acid sequence of any one of SEQ ID NOs: 4 or 13-30. In some embodiments, the amino acid sequence of the short segment and the ring domain together consists of the amino acid sequence of SEQ ID NO: 4. In some embodiments, the amino acid sequence of the short segment and the ring domain together consists of the amino acid sequence of any one of SEQ ID NOs: 119-122, 126, or 156-161 (e.g., where X in SEQ ID NO: 126 is Phe, Leu, Ile, Thr, Glu, Arg, Tyr, Cys, Pro, Asp, Gly, Ala, Ser, Val, Trp, Asn, Gln, His, or Lys, e.g., Phe, Leu, Ile, Thr, Glu, Arg, Tyr, Cys, Pro, or Asp, e.g., Phe or Leu, e.g., Phe, e.g., Leu). In some embodiments, the N-terminal extension, short segment, and ring domain together include the amino acid sequence of SEQ ID NO: 11. In some embodiments, the amino acid sequence of the NP consists of SEQ ID NO: 4. In some embodiments, the amino acid sequence of the NP consists of SEQ ID NO: 11. In some embodiments, the amino acid sequence of the NP consists of the amino acid sequence of any one of SEQ ID NOs: 31-94, or a fragment thereof including at least a ring domain. In some embodiments of the seventh aspect, the amino acid sequence of the NP includes or consists of the amino acid sequence of any one of SEQ ID NOs: 13-29, 100-116, 119-125, 127-233, or 1001-1155.

In any of the embodiments for the seventh aspect, the amino acid sequence of the short segment consists of amino acids 1-5 of SEQ ID NO: 4. In some embodiments, the amino acid sequence of the short segment consists of amino acids 1-5, 2-5, 3-5, 4-5, or 5 of SEQ ID NO: 4, amino acids 1-10 of SEQ ID NO: 17, amino acids 1-5 of SEQ ID NO: 19, amino acids 1-3 of SEQ ID NO: 20, amino acids 1-5 of SEQ ID NO: 21, or amino acids 1-6 of SEQ ID NO: 29. In some embodiments, the amino acid sequence of the N-terminal extension includes amino acids 1-31 of SEQ ID NO: 11. In some embodiments, the amino acid sequence of the N-terminal extension includes amino acids 17-31 of SEQ ID NO: 11. In some embodiments, the amino acid sequence of the N-terminal extension includes KGANKK (SEQ ID NO: 314) or KGANQK (SEQ ID NO: 315). In some embodiments, the C-terminal extension includes the amino acid sequence of SEQ ID NO: 118, SEQ ID NO: 117, or amino acids 23-37 selected from any one of SEQ ID NOs: 101-116.

In any of the embodiments of the seventh aspect, the NP is selective for NPR-B over NPR-A, wherein the EC_(50(NPR-A))/EC_(50(NPR-B)) ratio for the NP, as determined in an in vivo pharmacokinetic assay, is at least 30.

In any of the embodiments of the seventh aspect, the Fc includes a C_(H2) domain, a C_(H3) domain, and a hinge region. In some embodiments, the Fc is a constant domain of an immunoglobulin selected from the group consisting of IgG-1, IgG-2, IgG-3, IgG-3 and IgG-4. In some embodiments, the Fc includes the amino acid sequence of SEQ ID NO: 401. In some embodiments, the immunoglobulin is IgG-1. In some embodiments, the amino acid sequence of the Fc includes an amino acid sequence having at least 80%, 85%, 90%, 95%, or 99% sequence identity to SEQ ID NO: 401, or includes or consists of the amino acid sequence of SEQ ID NO: 401.

In any of the embodiments of the seventh aspect, Y includes a glycine-rich region, or the amino acid sequence of Y consists of one or more glycines and one or more serines. For example, the amino acid sequence of Y may include [(Gly)_(m)(Ser)]_(n)(Gly)_(p) or (Gly)_(p)[(Ser)(Gly)_(m)]_(n), wherein each of m, n, and p is, independently, between 0 and 20. In some embodiments, m is 0-20 (e.g., m is 3-6, 3-7, 3-8, 3-9, 3-10, 3-11, 3-12, 3-14, 3-15, 3-16, 3-17, 3-18, 3-19, 3-20, 4-6, 4-7, 4-8, 4-9, 4-10, 4-11, 4-12, 4-14, 4-15, 4-16, 4-17, 4-18, 4-19, 4-20, 5-6, 5-7, 5-8, 5-9, 5-10, 5-11, 5-12, 5-14, 5-15, 5-16, 5-17, 5-18, 5-19, 5-20, 6-7, 6-8, 6-9, 6-10, 6-11, 6-12, 6-14, 6-15, 6-16, 6-17, 6-18, 6-19, 6-20, 7-8, 7-9, 7-10, 7-11, 7-12, 7-14, 7-15, 7-16, 7-17, 7-18, 7-19, 7-20, 8-9, 8-10, 8-11, 8-12, 8-14, 8-15, 8-16, 8-17, 8-18, 8-19, 8-20, 9-10, 9-11, 9-12, 9-14, 9-15, 9-16, 9-17, 9-18, 9-19, 9-20, 10-11, 10-12, 10-14, 10-15, 10-16, 10-17, 10-18, 10-19, or 10-20). In some embodiments, m is 4 and n is 1-6. In some embodiments, combinations of m, n, and p are selected from a single row of Table 1, or the amino acid sequence of Y includes the amino acid sequence of any one of SEQ ID NOs: 304-313, 322-333, or 337-389. In some embodiments, the amino acid sequence of Y consists of [(Gly)_(m)(Ser)]_(n)(Gly)_(p) or (Gly)_(p)[(Ser)(Gly)_(m)]_(n), wherein combinations of m, n, and p are selected from a single row of Table 1, or the amino acid sequence of Y consists of the amino acid sequence of any one of SEQ ID NOs: 304-313, 322-333, or 337-389.

In some embodiments of the seventh aspect, X is absent, Z is absent, or X and Z are both absent.

In some embodiments of the seventh aspect, X, Y, or Z includes a bone-targeting moiety, e.g., including 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, or 16 consecutive acidic residues, e.g., aspartic acid or glutamic acid. In some embodiments, the bone-targeting moiety includes or consists of E₆, E₇, E₈, E₉, E₁₀, E₁₁, E₁₂, E₁₃, E₁₄, E₁₅, E₁₆, D₆, D₇, D₈, D₉, D₁₀, D₁₁, D₁₂, D₁₃, D₁₄, D₁₅, or D₁₆, e.g., E₆, E₁₀, D₆, or D₁₀.

In some embodiments of the seventh aspect, X, Y, or Z includes a cathepsin (e.g., cathepsin K) cleavage sequence. In some embodiments, the cathepsin cleavage sequence includes or consists of HGPQG (SEQ ID NO: 374) or HKLRG (SEQ ID NO: 375).

In some embodiments of the seventh aspect, the polypeptide includes or consists of the amino acid sequence of any one of SEQ ID NOs: 501-608, e.g., SEQ ID NO: 502, SEQ ID NO: 504, SEQ ID NO: 506, SEQ ID NO: 512, SEQ ID NO: 514, SEQ ID NO: 516, SEQ ID NO: 560, SEQ ID NO: 562, SEQ ID NO: 564, SEQ ID NO: 572, SEQ ID NO: 574, SEQ ID NO: 576, SEQ ID NO: 584, SEQ ID NO: 586, SEQ ID NO: 588, SEQ ID NO: 596, SEQ ID NO: 598, SEQ ID NO: 600, or SEQ ID NO: 608. In some embodiments, the polypeptide includes a bone-targeting moiety, e.g., E₆, E₇, E₈, E₉, E₁₀, E₁₁, E₁₂, E₁₃, E₁₄, E₁₅, E₁₆, D₆, D₇, D₈, D₉, D₁₀, D₁₁, D₁₂, D₁₃, D₁₄, D₁₅, or D₁₆, e.g., E₆, E₁₀, D₆, or D₁₀.

In some embodiments of the seventh aspect, the polypeptide includes or consists of the amino acid sequence of SEQ ID NO: 512.

In some embodiments of the seventh aspect, the polypeptide includes or consists of the amino acid sequence of SEQ ID NO: 554.

In some embodiments of the seventh aspect, the polypeptide includes or consists of the amino acid sequence of SEQ ID NO: 571

In some embodiments of the seventh aspect, the polypeptide includes or consists of the amino acid sequence of SEQ ID NO: 578.

In some embodiments of the seventh aspect, the polypeptide includes or consists of the amino acid sequence of SEQ ID NO: 560.

In some embodiments of the seventh aspect, the polypeptide includes or consists of the amino acid sequence of SEQ ID NO: 566.

In some embodiments of the seventh aspect, the polypeptide includes or consists of the amino acid sequence of SEQ ID NO: 538 (e.g., where X in SEQ ID NO: 538 can be any amino acid, e.g., Phe, Leu, Ile, Thr, Glu, Arg, Tyr, Cys, Pro, Asp, Gly, Ala, Ser, Val, Trp, Asn, Gln, His, or Lys, e.g., Phe, Leu, Ile, Thr, Glu, Arg, Tyr, Cys, Pro, or Asp, e.g., Phe or Leu, e.g., Phe, e.g., Leu).

In an eighth aspect, the invention features an isolated polypeptide, wherein the amino acid sequence of the polypeptide includes or consists of any one of SEQ ID NOs: 501-608, e.g., SEQ ID NO: 502, SEQ ID NO: 504, SEQ ID NO: 506, SEQ ID NO: 512, SEQ ID NO: 514, SEQ ID NO: 516, SEQ ID NO: 560, SEQ ID NO: 562, SEQ ID NO: 564, SEQ ID NO: 572, SEQ ID NO: 574, SEQ ID NO: 576, SEQ ID NO: 584, SEQ ID NO: 586, SEQ ID NO: 588, SEQ ID NO: 596, SEQ ID NO: 598, SEQ ID NO: 600, or SEQ ID NO: 608.

In a ninth aspect, the invention features an isolated polypeptide including the structure V-NP-W, wherein NP is a natriuretic peptide that is an agonist of natriuretic peptide receptor B (NPR-B); and each of V and W is, independently, absent or is an amino acid sequence of at least one amino acid; and the NP includes the amino acid sequence of any one of SEQ ID NOs: 101-116, 119-122, 128-161, or 163-233, or V or W includes the amino acid sequence of any one of SEQ ID NOs: 304-313, 322-333, or 337-389.

In a tenth aspect, the invention features an isolated polypeptide including the structure V-NP or NP-W, wherein NP is a natriuretic peptide that is an agonist of natriuretic peptide receptor B (NPR-B); each of V and W includes, independently, the amino acid sequence of any one of SEQ ID NOs: 304-313, 322-333, or 337-389.

In some embodiments of the ninth and tenth aspects, the polypeptide includes the structure V-NP.

In some embodiments of the ninth and tenth aspects, any of the NPs or polypeptides described herein may be used in conjunction with the method (e.g., NPs or polypeptides described in some embodiments of the first, second, and seventh aspects). In some embodiments, the amino acid sequence of V or W includes [(Gly)_(m)(Ser)]_(n)(Gly)_(p) or (Gly)_(p)[(Ser)(Gly)_(m)]_(n), wherein each of m, n, and p is, independently, between 0 and 20. In some embodiments, m is 4 and n is 1-6. In some embodiments, V is absent, W is absent, or V and W are both absent. In some embodiments, V or W includes a bone-targeting moiety, e.g., E₆, E₇, E₈, E₉, E₁₀, E₁₁, E₁₂, E₁₃, E₁₄, E₁₅, E₁₆, D₆, D₇, D₈, D₉, D₁₀, D₁₁, D₁₂, D₁₃, D₁₄, D₁₅, or D₁₆, e.g., E₆, E₁₀, D₆, or D₁₀. In some embodiments, V or W includes a cathepsin (e.g., cathepsin K) cleavage sequence, e.g., HGPQG (SEQ ID NO: 374) or HKLRG (SEQ ID NO: 375).

In some embodiments of the seventh, ninth, and tenth aspects, the NP includes any of the NPs or polypeptides described herein, e.g., including the structure: [N-terminal extension]-[short segment]-[ring domain]-[C-terminal extension], wherein the ring domain includes the amino acid sequence of SEQ ID NO: 6, amino acids 11-27 of SEQ ID NO: 30, or SEQ ID NO: 95, and each of the N-terminal extension, short segment, and C-terminal extension is, independently, absent or is an amino acid sequence of at least one amino acid. In some embodiments, the ring domain includes amino acids 6-22 of SEQ ID NO: 126. In other embodiments, the amino acid at position 17 of SEQ ID NO: 126 is Phe, Leu, Ile, Thr, Glu, Arg, Tyr, Cys, Pro, or Asp, e.g., Phe or Leu, e.g., Phe, e.g., Leu. In some embodiments, the amino acid sequence of the short segment and the ring domain together consists of the amino acid sequence of any one of SEQ ID NOs: 119-122, 126, or 156-161. In some embodiments, the amino acid sequence of the N-terminal extension includes amino acids 1-31 of SEQ ID NO: 11. In some embodiments, the amino acid sequence of the N-terminal extension includes amino acids 17-31 of SEQ ID NO: 11. In some embodiments, the amino acid sequence of the N-terminal extension includes KGANKK (SEQ ID NO: 314) or KGANQK (SEQ ID NO: 315). In some embodiments, the N-terminal extension, short segment, and ring domain together include the amino acid sequence of SEQ ID NO: 11. In some embodiments, the C-terminal extension includes the amino acid sequence of SEQ ID NO: 118, SEQ ID NO: 117, or amino acids 23-37 selected from any one of SEQ ID NOs: 101-116. In some embodiments, the amino acid sequence of the NP consists of SEQ ID NO: 4. In some embodiments, the amino acid sequence of the NP consists of SEQ ID NO: 11. In some embodiments, the amino acid sequence of the NP consists of the amino acid sequence of any one of SEQ ID NOs: 31-94, or a fragment thereof including at least a ring domain.

In some embodiments of the seventh, eighth, ninth, and tenth aspects, the polypeptide is glycosylated or pegylated. In some embodiments, a pharmaceutical composition includes a dimer of the polypeptide.

In some embodiments of any of the above aspects, any of the polypeptides described herein may include a bone-targeting moiety, e.g., E₆, E₇, E₈, E₉, E₁₀, E₁₁, E₁₂, E₁₃, E₁₄, E₁₅, E₁₆, D₆, D₇, D_(a), D₉, D₁₀, D₁₁, D₁₂, D₁₃, D₁₄, D₁₅, or D₁₆, e.g., E₆, E₁₀, D₆, or D₁₀.

In some embodiments of any of the above aspects, any of the polypeptides described herein may include a cathepsin (e.g., cathepsin K) cleavage sequence, e.g., HGPQG (SEQ ID NO: 374) or HKLRG (SEQ ID NO: 375).

In some embodiments of any of the above aspects, any of the polypeptides described herein may include a polypeptide having reduced (e.g., by about 20%, about 25%, about 30%, about 35%, about 40%, about 45%, about 50%, about 55%, about 60%, about 65%, about 70%, about 75%, about 80%, about 85%, about 90%, about 95%, about 96%, about 97%, about 98%, about 99%, or about 100%) degradation (e.g., by neutral endopeptidase (NEP), insulin degrading enzyme (IDE), or any other enzyme that cleaves a natriuretic peptide in vivo), as compared to a control (e.g., CNP22, CNP53, or any polypeptide described herein, such as a peptide described in International Application Pub. No. WO2010/135541 or U.S. Application Pub. No. 2010-0331256).

In some embodiments of any of the above aspects, the polypeptides described herein have increased (e.g., by about 20%, about 25%, about 30%, about 35%, about 40%, about 45%, about 50%, about 55%, about 60%, about 65%, about 70%, about 75%, about 80%, about 85%, about 90%, about 95%, about 96%, about 97%, about 98%, about 99%, about 100%, or more) efficacy and/or reduced (e.g., by about 20%, about 25%, about 30%, about 35%, about 40%, about 45%, about 50%, about 55%, about 60%, about 65%, about 70%, about 75%, about 80%, about 85%, about 90%, about 95%, about 96%, about 97%, about 98%, about 99%, or about 100%) dose-dependent side effects (e.g., decreased adverse hemodynamic effects, such as decreased lowering of blood pressure), as compared to a control (e.g., any polypeptide described herein, such as a peptide described in International Application Pub. No. WO2010/135541 or U.S. Application Pub. No. 2010-0331256).

In an eleventh aspect, the invention features a pharmaceutical composition including: (a) any of the isolated polypeptides as described herein; and (b) a pharmaceutically acceptable excipient. In some embodiments, the pharmaceutical composition is formulated for treating a disorder associated with overactivation of FGFR3, e.g., a bone or cartilage disorder, e.g., a skeletal dysplasia, e.g., any of the skeletal dysplasias described herein, e.g., achondroplasia or, e.g., craniosynostosis. In some embodiments, the pharmaceutical composition is formulated for treating bone or cartilage disorder, e.g., a skeletal dysplasia, e.g., any of the skeletal dysplasias described herein, e.g., achondroplasia or, e.g., craniosynostosis (e.g., Muenke syndrome, Crouzon syndrome, Apert syndrome, Jackson-Weiss syndrome, Pfeiffer syndrome, or Crouzonodermoskeletal syndrome). In some embodiments, the disorder associated with overactivation of FGFR3 is cancer, e.g., any of the cancers described herein, e.g., multiple myeloma. In some embodiments, the pharmaceutical composition is formulated for treating a vascular smooth muscle disorder, e.g., any of the vascular smooth muscle disorders described herein. In some embodiments, the pharmaceutical composition is formulated for elongating bone, e.g., any of the conditions or disorders described herein that would benefit from bone elongation.

In a twelfth aspect, the invention features a method of treating a disorder associated with overactivation of FGFR3, a bone or cartilage disorder, or a vascular smooth muscle disorder in a subject, the method including administering to the subject a therapeutically effective amount of a pharmaceutical composition including: (a) an isolated nucleic acid molecule encoding any of the polypeptides described herein; and (b) a pharmaceutically acceptable excipient. In some embodiments, the disorder associated with overactivation of FGFR3, bone or cartilage disorder, or vascular smooth muscle disorder in the subject is thereby treated.

In some embodiments of the eleventh and twelfth aspects, the pharmaceutically acceptable excipient includes saline. In some embodiments, the pharmaceutical composition is lyophilized. In some embodiments, the pharmaceutical composition is administered subcutaneously, intravenously, orally, nasally, intramuscularly, sublingually, intrathecally, or intradermally.

In some embodiments, the pharmaceutical composition is administered to the subject in a dosage between about 0.5 mg/kg to about 500 mg/kg once, twice, three times, or four times daily. The dosage may be between, e.g., about 5 mg/kg to about 200 mg/kg, e.g., about 10 mg/kg to about 100 mg/kg, once, twice, three times, or four times daily. In some embodiments, the dosage is about 10 mg/kg or about 100 mg/kg twice daily.

In some embodiments, the pharmaceutical composition is administered to the subject in a dosage between about 0.5 mg/kg to about 500 mg/kg once or twice weekly. The dosage may be between, e.g., about 5 mg/kg to about 200 mg/kg, e.g., about 10 mg/kg to about 100 mg/kg, e.g., about 20 mg/kg to about 40 mg/kg, once or twice weekly. In some embodiments, the dosage is about 10 mg/kg, about 30 mg/kg, or about 100 mg/kg, once or twice weekly.

In some embodiments, the pharmaceutical composition is administered to the subject in a dosage between about 10 μg/kg to about 1,000 μg/kg once or twice weekly. The dosage may be between, e.g., about 20 μg/kg to about 800 vg/kg, e.g., about 30 μg/kg to about 600 μg/kg, e.g., about 50 μg/kg to about 500 μg/kg, e.g., about 100 μg/kg to about 400 μg/kg, e.g., about 200 μg/kg to about 300 μg/kg, once or twice weekly. In some embodiments, the dosage is about 30 μg/kg, about 100 μg/kg, about 300 μg/kg, or about 500 μg/kg, once or twice weekly. In some embodiments, the pharmaceutical composition is administered to the subject between one and fourteen times per week, or is administered at least once daily for at least one month. In preferred embodiments, the pharmaceutical composition is administered to the subject once weekly for at least one month.

In a thirteenth aspect, the invention features a method of elongating bone in a subject, the method including administering to the subject a therapeutically effective amount of a pharmaceutical composition including: (a) an isolated nucleic acid molecule encoding any of the polypeptides described herein; and (b) a pharmaceutically acceptable excipient.

In some embodiments of the twelfth and thirteenth aspects, the pharmaceutical composition is administered to the subject in a lentiviral vector. In some embodiments, the pharmaceutical composition is administered to the subject at a dosage of from about 0.1 mg to about 10 mg of the isolated nucleic acid.

In a fourteenth aspect, the invention features an isolated nucleic acid molecule encoding any of the polypeptides described herein.

In a fifteenth aspect, the invention features an isolated nucleic acid molecule including the nucleic acid sequence of any one of SEQ ID NOs: 801-806, or including a nucleic acid sequence encoding a polypeptide encoded by any one of SEQ ID NOs: 801-806.

In some embodiments, any of the isolated nucleic acid molecules described herein include a recombinant expression vector, e.g., a lentiviral vector, capable of expressing the polypeptide encoded by the nucleic acid molecule.

In a sixteenth aspect, the invention features an isolated recombinant host cell, e.g., a HEK293 cell, an L cell, a C127 cell, a 3T3 cell, a CHO cell, a BHK cell, or a COS-7 cell, transformed or transfected with any of the isolated nucleic acid molecules described herein.

In a seventeenth aspect, the invention features a pharmaceutical composition including: (a) any of the isolated nucleic acid molecules as described herein; and (b) a pharmaceutically acceptable excipient. In some embodiments, the pharmaceutical composition is formulated for treating a disorder associated with overactivation of FGFR3, e.g., a bone or cartilage disorder, e.g., a skeletal dysplasia, e.g., any of the skeletal dysplasias described herein, e.g., achondroplasia or, e.g., craniosynostosis. In some embodiments, the pharmaceutical composition is formulated for treating a bone or cartilage disorder, e.g., a skeletal dysplasia, e.g., any of the skeletal dysplasias described herein, e.g., achondroplasia or, e.g., craniosynostosis (e.g., Muenke syndrome, Crouzon syndrome, Apert syndrome, Jackson-Weiss syndrome, Pfeiffer syndrome, or Crouzonodermoskeletal syndrome). In some embodiments, the disorder associated with overactivation of FGFR3 is cancer, e.g., any of the cancers described herein, e.g., multiple myeloma. In some embodiments, the pharmaceutical composition is formulated for treating a vascular smooth muscle disorder, e.g., any of the vascular smooth muscle disorders described herein. In some embodiments, the pharmaceutical composition is formulated for elongating bone, e.g., any of the conditions or disorders described herein that would benefit from bone elongation.

In an eighteenth aspect, the invention features a method of producing any of the polypeptides described herein, including culturing any of the host cells described herein in a culture medium under conditions suitable to effect expression of the polypeptide and recovering the polypeptide from the culture medium. In some embodiments, the host cell is a HEK293 cell, an L cell, a C127 cell, a 3T3 cell, a CHO cell, a BHK cell, or a COS-7 cell.

In a nineteenth aspect, the invention features a kit including: (a) any of the pharmaceutical compositions described herein; and (b) instructions for administering the pharmaceutical composition to a subject to treat a disorder associated with overactivation of FGFR3, e.g., any of the disorders associated with overactivation of FGFR3 described herein, e.g., achondroplasia, a bone or cartilage disorder, e.g., any skeletal dysplasia described herein, e.g., craniosynostosis (e.g., Muenke syndrome, Crouzon syndrome, Apert syndrome, Jackson-Weiss syndrome, Pfeiffer syndrome, or Crouzonodermoskeletal syndrome), or a vascular smooth muscle disorder, e.g., any of the vascular smooth muscle disorders described herein.

In a twentieth aspect, the invention features a kit including: (a) any of the pharmaceutical compositions described herein; and (b) instructions for administering the pharmaceutical composition to a subject to elongate bone, e.g., any condition or disorder described herein that would benefit from bone elongation.

In a twenty-first aspect, the invention features a method of treating a disorder associated with overactivation of FGFR3, a bone or cartilage disorder, or a vascular smooth muscle disorder in a subject, e.g., a human, the method including administering to the subject a therapeutically effective amount of a pharmaceutical composition including: (a) a polypeptide of the seventh, eighth, ninth, or tenth aspect, as described herein, and (b) a pharmaceutically acceptable excipient; or a therapeutically effective amount of a pharmaceutical composition of the eleventh aspect, as described herein. In some embodiments, the disorder associated with overactivation of FGFR3, bone or cartilage disorder, or vascular smooth muscle disorder in the subject is thereby treated.

In a twenty-second aspect, the invention features a method of elongating bone in a subject, e.g., a human, the method including administering to the subject a therapeutically effective amount of a pharmaceutical composition including: (a) a polypeptide of the seventh, eighth, ninth, or tenth aspect, as described herein, and (b) a pharmaceutically acceptable excipient; or a therapeutically effective amount of a pharmaceutical composition of the eleventh aspect, as described herein.

In a twenty-third aspect, the invention features a method of treating a disorder associated with overactivation of FGFR3, a bone or cartilage disorder, or a vascular smooth muscle disorder in a subject, e.g., a human, the method including administering to the subject a therapeutically effective amount of a pharmaceutical composition including: (a) an isolated nucleic acid molecule of the fourteenth or fifteenth aspect, as described herein, and (b) a pharmaceutically acceptable excipient; or a therapeutically effective amount of a pharmaceutical composition of the seventeenth aspect, as described herein. In some embodiments, the disorder associated with overactivation of FGFR3, bone or cartilage disorder, or vascular smooth muscle disorder in the subject is thereby treated.

In a twenty-fourth aspect, the invention features a method of elongating bone in a subject, e.g., a human, the method including administering to the subject a therapeutically effective amount of a pharmaceutical composition including: (a) an isolated nucleic acid molecule of the fourteenth or fifteenth aspect, as described herein, and (b) a pharmaceutically acceptable excipient; or a therapeutically effective amount of a pharmaceutical composition of the seventeenth aspect, as described herein.

In some embodiments of the twenty-third and twenty-fourth aspects, the pharmaceutical composition is administered to the subject in a lentiviral vector. In some embodiments, the pharmaceutical composition is administered to the subject at a dosage of from about 0.1 mg to about 10 mg of the isolated nucleic acid.

In any of the embodiments described herein, the polypeptide may or may not be isolated.

As used herein, the term “about” means±10% of the recited value.

By “area under the curve” or “AUC” in the context of an in vivo pharmacokinetic assay is meant the area under the serum concentration vs. time curve after administration in an animal.

By “bone or cartilage disorder” is meant any disorder, disease, or other abnormality that affects the function, structure, or growth of bone or cartilage.

By “bone-targeting moiety” is meant an amino acid sequence of between 6 and 20 amino acid residues in length having a sufficient affinity to the bone matrix such that the bone-targeting moiety, taken alone, has an in vivo binding affinity to the bone matrix that is at least 10⁻⁶ M or better (e.g., 10⁻⁷M, 10⁻⁸M, 10⁻⁹M, or better).

By “cathepsin cleavage sequence” is meant an amino acid sequence having a site that can be cleaved by cathepsin with a k_(cat)/K_(M) rate constant of at least 10³ M⁻¹s⁻¹ (e.g., 10⁴ M⁻¹s⁻¹, 10⁵ M⁻¹s⁻¹, 10⁶ M⁻¹s⁻¹, 10⁷ M⁻¹s⁻¹, or 10⁸M⁻¹s⁻¹) at 30° C. or higher (e.g., 37° C.). In particular embodiments, the cathepsin cleavage sequence is specific for cathepsin K. Exemplary cathepsin cleavage sequences are P2-P1-P1′, where cleavage by the enzyme would occur at the P1-P1′ peptide bond; P2 is preferentially composed of Pro, Leu, Ile, but could also be Val, Norleucine, Met, or Ala; P1 is preferentially Arg, Lys, Gln, but could also be Met, Norleucine, Leu, Ile, or Thr; and P1′ can be any amino acid but is preferentially Gly. Additional cathepsin cleavage sequences are provided in Choe et al., J. Biol. Chem. 281(18):12824-832, 2006, which is incorporated herein by reference.

By “CNP22” is meant human CNP22 (SEQ ID NO: 4), unless a different meaning is expressly indicated.

By “CNP53” is meant human CNP53 (SEQ ID NO: 11), unless a different meaning is expressly indicated.

By “disorder associated with overactivation of FGFR3” is meant any disorder, disease, or other abnormality that is caused by, or is associated with, overactivation of FGFR3, e.g., stemming from a gain-of-function FGFR3 mutation.

By “efficacy” is meant the E_(max) value of a compound in a dose-response assay.

By “Fe” is meant a fragment crystallizable region of an immunoglobulin, e.g., IgG-1, IgG-2, IgG-3, IgG-3 or IgG-4, including the C_(H2) and C_(H3) domains of the immunoglobulin heavy chain. Fc may also include any portion of the hinge region joining the Fab and Fc regions. The Fc can be of any mammal, including human, and may be post-translationally modified (e.g., by glycosylation). In a non-limiting example, Fc can be the fragment crystallizable region of human IgG-1 having the amino acid sequence of SEQ ID NO: 401.

By “fragment” is meant a portion of a polypeptide or nucleic acid molecule that contains, preferably, at least 10%, 20%, 30%, 40%, 50%, 60%, 70%, 75%, 80%, 85%, 90%, 95%, 96%, 97%, 98%, 99%, or more of the entire length of the reference nucleic acid molecule or polypeptide. A fragment may contain, e.g., 10, 15, 20, 25, 30, 35, 40, 45, 50, 55, 60, 65, 70, 75, 80, 85, 90, 95, 100, 110, 120, 130, 140, 150, 160, 170, 180, 190, 200, 210, 220, 230, 240, 250, 260, 270, 280, 290, 300, 310, 320, 330, 340, 350, 360, 370, 380, 390, 400, 500, 600, 700, 800, 900, 1,000, or more nucleotides, up to the entire length of the nucleic acid molecule, or 10, 15, 20, 25, 30, 35, 40, 45, 50, 55, 60, 65, 70, 75, 80, 85, 90, 95, 100, 110, 120, 130, 140, 150, 160, 170, 180, 190, 200, 210, 220, 230, 240, 250, 260, 270, 280, 290, 300, or more amino acids, up to the entire length of the polypeptide. Exemplary NP fragments have at least a consensus ring domain, e.g., of SEQ ID NOs: 6, 30, or 95, and may include additional N-terminal and/or C-terminal portions.

By “homolog” is meant a polypeptide or nucleic acid molecule exhibiting at least 50% identity to a reference amino acid sequence or nucleic acid sequence. Such a sequence is generally at least, e.g., 50%, 60%, 70%, 75%, 80%, 85%, 90%, 95%, 96%, 97%, 98%, or 99% identical at the amino acid level or nucleic acid to a reference sequence. In general, for polypeptides, the length of comparison sequences can be at least five amino acids, e.g., 10, 20, 30, 40, 50, 60, 70, 80, 90, 100, 125, 150, 175, 200, 250, 300, or more amino acids, up to the entire length of the polypeptide. For nucleic acids, the length of comparison sequences can generally be at least 10, 20, 30, 40, 50, 60, 70, 80, 90, 100, 125, 150, 175, 200, 250, 300, 400, 500, 600, 700, 800, 900, 1000, or more nucleotides, up to the entire length of the nucleic acid molecule. It is understood that for the purposes of determining sequence identity when comparing a DNA sequence to an RNA sequence, a thymine nucleotide is equivalent to a uracil nucleotide.

As used herein, when a polypeptide or nucleic acid sequence is referred to as having “at least X % sequence identity” to a reference sequence, it is meant that at least X percent of the amino acids or nucleotides in the polypeptide or nucleic acid are identical to those of the reference sequence when the sequences are optimally aligned. An optimal alignment of sequences can be determined in various ways that are within the skill in the art, for instance, the Smith Waterman alignment algorithm (Smith et al., J. Mol. Biol. 147:195-7, 1981) and BLAST (Basic Local Alignment Search Tool; Altschul et al., J. Mol. Biol. 215: 403-10, 1990). These and other alignment algorithms are accessible using publicly available computer software such as “Best Fit” (Smith and Waterman, Advances in Applied Mathematics, 482-489, 1981) as incorporated into GeneMatcher Plus™ (Schwarz and Dayhof, Atlas of Protein Sequence and Structure, Dayhoff, M. O., Ed pp 353-358, 1979), BLAST, BLAST-2, BLAST-P, BLAST-N, BLAST-X, WU-BLAST-2, ALIGN, ALIGN-2, CLUSTAL, or Megalign (DNASTAR). In addition, those skilled in the art can determine appropriate parameters for measuring alignment, including any algorithms needed to achieve optimal alignment over the length of the sequences being compared.

By “hybridize” is meant to pair to form a double-stranded molecule between complementary polynucleotides, or portions thereof, under various conditions of stringency. (See, e.g., Wahl, G. M. and S. L. Berger (1987) Methods Enzymol. 152:399; Kimmel, A. R. (1987) Methods Enzymol. 152:507.) For example, high stringency salt concentration will ordinarily be less than about 750 mM NaCl and 75 mM trisodium citrate, less than about 500 mM NaCl and 50 mM trisodium citrate, or less than about 250 mM NaCl and 25 mM trisodium citrate. Low stringency hybridization can be obtained in the absence of organic solvent, e.g., formamide, while high stringency hybridization can be obtained in the presence of at least about 35% formamide or at least about 50% formamide. High stringency temperature conditions will ordinarily include temperatures of at least about 30° C., 37° C., or 42° C. Varying additional parameters, such as hybridization time, the concentration of detergent, e.g., sodium dodecyl sulfate (SDS), and the inclusion or exclusion of carrier DNA, are well known to those skilled in the art. Various levels of stringency are accomplished by combining these various conditions as needed. In one embodiment, hybridization will occur at 30° C. in 750 mM NaCl, 75 mM trisodium citrate, and 1% SDS. In an alternative embodiment, hybridization will occur at 37° C. in 500 mM NaCl, 50 mM trisodium citrate, 1% SDS, 35% formamide, and 100 μg/ml denatured salmon sperm DNA (ssDNA). In a further alternative embodiment, hybridization will occur at 42° C. in 250 mM NaCl, 25 mM trisodium citrate, 1% SDS, 50% formamide, and 200 μg/ml ssDNA. Useful variations on these conditions will be readily apparent to those skilled in the art.

For most applications, washing steps that follow hybridization will also vary in stringency. Wash stringency conditions can be defined by salt concentration and by temperature. As above, wash stringency can be increased by decreasing salt concentration or by increasing temperature. For example, high stringency salt concentrations for the wash steps may be, e.g., less than about 30 mM NaCl and 3 mM trisodium citrate, or less than about 15 mM NaCl and 1.5 mM trisodium citrate. High stringency temperature conditions for the wash steps will ordinarily include a temperature of, e.g., at least about 25° C., 42° C., or 68° C. In one embodiment, wash steps will occur at 25° C. in 30 mM NaCl, 3 mM trisodium citrate, and 0.1% SDS. In an alternative embodiment, wash steps will occur at 42° C. in 15 mM NaCl, 1.5 mM trisodium citrate, and 0.1% SDS. In a further alternative embodiment, wash steps will occur at 68° C. in 15 mM NaCl, 1.5 mM trisodium citrate, and 0.1% SDS. Additional variations on these conditions will be readily apparent to those skilled in the art. Hybridization techniques are well known to those skilled in the art and are described, for example, in Benton and Davis (Science 196:180, 1977); Grunstein and Hogness (Proc. Natl. Acad. Sci., USA 72:3961, 1975); Ausubel et al. (Current Protocols in Molecular Biology, Wiley Interscience, New York, 2001); Berger and Kimmel (Guide to Molecular Cloning Techniques, 1987, Academic Press, New York); and Sambrook et al., Molecular Cloning: A Laboratory Manual, Cold Spring Harbor Laboratory Press, New York.

By “isolated” or “purified” is meant separated from other naturally accompanying components. Typically, a compound (e.g., polypeptide, nucleic acid, or small molecule), factor, cell, or other component is considered isolated when it is at least, e.g., 50%, 60%, 70%, 75%, 80%, 85%, 90%, 95%, 96%, 97%, 98%, or even 99%, by weight, free from proteins, antibodies, naturally-occurring organic molecules, and other components with which it is naturally associated. In some instances, the component is at least 75%, 90%, or even 99%, by weight, pure. An isolated component may be obtained by chemical synthesis, separation of the factor from natural sources, or production of the component in a recombinant host cell that does not naturally produce the component. Proteins and small molecules may be purified by one skilled in the art using standard techniques such as those described by Ausubel et al. (Current Protocols in Molecular Biology, John Wiley & Sons, New York, 2000). The component is preferably at least, e.g., 2, 5, or 10 times as pure as the starting material, as measured using, e.g., polyacrylamide gel electrophoresis, column chromatography, optical density, HPLC analysis, or Western analysis (Ausubel et al., supra). Exemplary methods of purification are column chromatography, immunoprecipitation, and magnetic bead immunoaffinity purification.

By “natriuretic peptide that is an agonist of natriuretic peptide receptor B” (abbreviated “NP”) is meant a natriuretic peptide as described herein, e.g., human CNP22 (SEQ ID NO: 4), or variant thereof, that is capable of agonizing NPR-B, e.g., human NPR-B, with at least 0.000001, 0.000005, 0.00001, 0.00005, 0.0001, 0.0005, 0.001, 0.005, 0.01, 0.05, 0.1, 0.5, 0.9, or 1 times the potency, and at least 1%, 2%, 5%, 10%, 20%, 30%, 40%, 50%, 60%, 70%, 80%, 90%, 95%, 95%, or even 100% times the efficacy of CNP22 as measured in a standard NPR-B activation assay, e.g., a membrane assay or whole cell assay, as described herein. Variant NPs may include one or more substitutions, additions or deletions relative to CNP22 and have the ability to agonize NPR-B. An NP as described herein may include any other sequence or moiety, attached covalently or non-covalently, provided that the NP has the ability to agonize NPR-B.

By “nucleic acid molecule” is meant a molecule, e.g., RNA or DNA, having a sequence of two or more covalently bonded, naturally occurring or modified nucleotides. The nucleic acid molecule may be, e.g., single or double stranded, and may include modified or unmodified nucleotides, or mixtures or combinations thereof. Various salts, mixed salts, and free acid forms are also included.

The terms “peptide,” “polypeptide,” and “protein” are used interchangeably and refer to any chain of two or more natural or unnatural amino acids, regardless of post-translational modification (e.g., glycosylation or phosphorylation), constituting all or part of a naturally-occurring or non-naturally occurring polypeptide or peptide, as is described herein.

As used herein, a natural amino acid is a natural α-amino acid having the L-configuration, such as those normally occurring in natural polypeptides. Unnatural amino acid refers to an amino acid that normally does not occur in polypeptides, e.g., an epimer of a natural α-amino acid having the L configuration, that is to say an amino acid having the unnatural D-configuration; or a (D,L)-isomeric mixture thereof; or a homolog of such an amino acid, for example, a J3-amino acid, an α,α-disubstituted amino acid, or an α-amino acid wherein the amino acid side chain has been shortened by one or two methylene groups or lengthened to up to 10 carbon atoms, such as an α-amino alkanoic acid with 5 up to and including 10 carbon atoms in a linear chain, an unsubstituted or substituted aromatic (α-aryl or α-aryl lower alkyl), for example, a substituted phenylalanine or phenylglycine.

By “pharmaceutically acceptable carrier” or “pharmaceutically acceptable excipient” is meant a carrier or excipient that is physiologically acceptable to the treated patient while retaining the therapeutic properties of the compound with which it is administered. One exemplary pharmaceutically acceptable carrier substance is physiological saline. Other physiologically acceptable carriers and their formulations are known to those skilled in the art and described, for example, in Remington's Pharmaceutical Sciences, (20th edition), ed. A. Gennaro, 2000, Lippincott, Williams & Wilkins, Philadelphia, Pa.

By “pharmaceutical composition” is meant a composition containing a polypeptide or nucleic acid molecule as described herein formulated with a pharmaceutically acceptable excipient, and manufactured or sold with the approval of a governmental regulatory agency as part of a therapeutic regimen for the treatment or prevention of a disease or event in a subject. Pharmaceutical compositions can be formulated, for example, for subcutaneous administration, intravenous administration (e.g., as a sterile solution free of particulate emboli and in a solvent system suitable for intravenous use), for oral administration (e.g., a tablet, capsule, caplet, gelcap, or syrup), or any other formulation described herein, e.g., in unit dosage form.

By “skeletal dysplasia” is meant a bone or cartilage disorder characterized by short stature or dwarfism.

By “potency” is meant the reciprocal of the EC₅₀ value of a compound in a dose-response assay. When comparing potency between a compound and a control or between an assay and a control assay, decreased potency indicates an increased EC₅₀ value, and increased potency indicates a decreased EC₅₀ value, as compared to the EC₅₀ value for the control or the control assay.

By “reduced degradation” is meant having a lower percentage of degraded peptide after exposure to an enzyme for at least 5, 10, 15, 20, 25, 30, 60, 120, 180, or 240 minutes, or higher, or any range between any two of these values, as compared to a percentage of degraded control, such as CNP22, CNP53, or any polypeptide described herein, such as a peptide described in International Application Pub. No. WO2010/135541 or U.S. Application Pub. No. 2010-0331256. The percentage of degraded peptide can be lower by about 20%, about 25%, about 30%, about 35%, about 40%, about 45%, about 50%, about 55%, about 60%, about 65%, about 70%, about 75%, about 80%, about 85%, about 90%, about 95%, about 96%, about 97%, about 98%, about 99%, or about 100%, where the percentage of degraded peptide can be determined by measuring the percentage of degraded peptide directly or indirectly by measuring the percentage of remaining peptide after exposure to an enzyme (e.g., neutral endopeptidase, insulin degrading enzyme, and any other enzyme that cleaves a natriuretic peptide in vivo) and subtracting this percentage of remaining peptide from 100%. Percentage of degraded peptide or remaining peptide can be measured by any useful method, such as liquid chromatography (e.g., high performance liquid chromatography (HPLC)), mass spectrometry (MS), or combined analytic techniques (e.g., LC-MS).

By “reduced dose-dependent side effect” is meant a decrease in one or more adverse effects as a function of a dosage of a compound, as compared to a control (e.g., any polypeptide described herein, such as a peptide described in International Application Pub. No. WO2010/135541 or U.S. Application Pub. No. 2010-0331256). The decrease in one or more adverse effects can be by about 20%, about 25%, about 30%, about 35%, about 40%, about 45%, about 50%, about 55%, about 60%, about 65%, about 70%, about 75%, about 80%, about 85%, about 90%, about 95%, about 96%, about 97%, about 98%, about 99%, or about 100%, as determined by any useful assay for detecting the adverse effect. Exemplary adverse effects include hemodynamic effects, such as a decrease in blood pressure, such as systolic arterial blood pressure, diastolic arterial blood pressure, or mean arterial blood pressure, that results in adverse hypotensive effects, and assays to detect such hemodynamic effects include a sphygmomanometer or an implanted pressure transducer.

By “selective for NPR-B over NPR-A” is meant having an EC_(50(NPR-A)/EC) _(50(NPR-B)) ratio that is at least 1.25, 1.5, 2, 2.5, 3, 3.5, 4, 4.5, 5, 7.5, 10, 12.5, 15, 20, 25, 30, 35, 40, 45, 50, 55, 60, 65, 70, 75, 80, 85, 90, 95, 100, 110, 120, 125, 130, 140, 150, 160, 170, 180, 190, 200, 225, 250, 275, 300, 350, 400, 450, 500, 550, 600, 650, 700, 750, 800, 850, 900, 950, 1,000, 1,100, 1,200, 1,250, 1,300, 1,400, 1,500, 1,750, 2,000, 2,500, 3,000, 4,000, 5,000, 10,000, or higher, or any range between any two of these values, in an in vivo or in vitro dose-response assay, e.g., measuring cGMP production, as described herein. Alternatively, or in addition, the term “selective for NPR-B over NPR-A” means having an AUC_((NPR-B))/AUC_((NPR-A)) ratio that is at least 1.1, 1.2, 1.25, 1.3, 1.4, 1.5, 1.6, 1.7, 1.75, 1.8, 1.9, 2, 2.25, 2.5, 2.75, 3, 3.5, 4, 4.5, 5, 7.5, 10, 12.5, 15, 20, 25, 30, 35, 40, 45, 50, 55, 60, 65, 70, 75, 80, 85, 90, 95, 100, 110, 120, 125, 130, 140, 150, 160, 170, 180, 190, 200, 225, 250, 275, 300, 350, 400, 450, 500, 550, 600, 650, 700, 750, 800, 850, 900, 950, 1,000, 1,100, 1,200, 1,250, 1,300, 1,400, 1,500, 1,750, 2,000, 2,500, 3,000, 4,000, 5,000, 10,000, or higher, or any range between any two of these values, as described herein.

By “signal peptide” or “signal sequence” is meant an amino acid sequence that directs a polypeptide to the cellular membrane such that the polypeptide is secreted. Alternatively, the signal sequence may direct the polypeptide to an intracellular compartment or organelle, such as the Golgi apparatus. A signal sequence may be identified by homology, or biological activity, to a peptide sequence with the known function of targeting a polypeptide to a particular region of the cell. One of ordinary skill in the art can identify a signal sequence by using readily available software (e.g., Sequence Analysis Software Package of the Genetics Computer Group, University of Wisconsin Biotechnology Center, 1710 University Avenue, Madison, Wis. 53705, BLAST, or PILEUP/PRETTYBOX programs). A signal sequence can be one that is, for example, substantially identical to amino acids 1-25 of SEQ ID NO: 501.

By “subject” is meant a mammal, including, but not limited to, a human or non-human mammal, such as a bovine, equine, canine, ovine, or feline.

By “therapeutically effective amount” is meant an amount of a polypeptide or nucleic acid molecule described herein that is sufficient to substantially treat, prevent, delay, suppress, or arrest any symptom of a disorder associated with overactivation of FGFR3, a bone or cartilage disorder (e.g., achondroplasia), or a vascular smooth muscle disorder, or that is sufficient to substantially elongate bone. A therapeutically effective amount of a composition described herein may depend on the severity of the disorder being treated and the condition, weight, and general state of the subject and can be determined by an ordinarily-skilled artisan with consideration of such factors. A therapeutically effective amount of a composition described herein can be administered to a subject in a single dose or in multiple doses administered over a period of time.

By “treating,” “treat,” or “treatment” is meant the medical management of a patient with the intent to cure, ameliorate, stabilize, reduce the likelihood of, or prevent a disorder associated with overactivation of FGFR3, a bone or cartilage disorder (e.g., achondroplasia), or a vascular smooth muscle disorder, or management of a healthy subject with the intent to elongate bone, e.g., by administering a pharmaceutical composition. This term includes active treatment, that is, treatment directed specifically toward the improvement or associated with the cure of a disease, pathological condition, disorder, or event, and also includes causal treatment, that is, treatment directed toward removal of the cause of the associated disease, pathological condition, disorder, or event. In addition, this term includes palliative treatment, that is, treatment designed for the relief of symptoms rather than the curing of the disease, pathological condition, disorder, or event; symptomatic treatment, that is, treatment directed toward constitutional symptoms of the associated disease, pathological condition, disorder, or event; preventative treatment, that is, treatment directed to minimizing or partially or completely inhibiting the development of the associated disease, pathological condition, disorder, or event, e.g., in a patient who is not yet ill, but who is susceptible to, or otherwise at risk of, a particular disease, pathological condition, disorder, or event; and supportive treatment, that is, treatment employed to supplement another specific therapy directed toward the improvement of the associated disease, pathological condition, disorder, or event.

By “vascular smooth muscle disorder” is meant any disorder, disease, or other abnormality that affects the function, structure, or growth of vascular smooth muscle.

By “vector” is meant a DNA molecule, usually derived from a plasmid or bacteriophage, into which fragments of DNA may be inserted or cloned. A recombinant vector will contain one or more unique restriction sites, and may be capable of autonomous replication in a defined host or vehicle organism such that the cloned sequence is reproducible. A vector contains a promoter operably linked to a gene or coding region such that, upon transfection into a recipient cell, an RNA is expressed.

Other features and advantages of the invention will be apparent from the detailed description and from the claims.

BRIEF DESCRIPTION OF THE DRAWINGS

In figures showing a multiple sequence alignment, “*” represents identity; “:” represents a conserved substitution; and “.” represents a semi-conserved substitution.

FIG. 1 is a multiple sequence alignment of human ANP (SEQ ID NO: 1), human urodilatin (SEQ ID NO: 2), human BNP (SEQ ID NO: 3), human CNP22 (SEQ ID NO: 4), and DNP (SEQ ID NO: 5). The 17-amino acid ring domain for each natriuretic peptide is shown in bold and enclosed in a box. A consensus sequence (SEQ ID NO: 6) is shown below, wherein each X represents any amino acid, or optionally represents any amino acid at the corresponding position in one of SEQ ID NOs: 1-5.

FIG. 2 is an alignment of human CNP53 (SEQ ID NO: 11), human CNP22, and human CNP (ring domain only) (SEQ ID NO: 12).

FIG. 3 is a multiple sequence alignment of various CNP22 homologs. The 17-amino acid ring domain for each NP is shown in bold and enclosed in a box. A consensus sequence (SEQ ID NO: 30) is shown below, wherein each X within the ring domain represents any amino acid, or optionally represents any amino acid at the corresponding position in one of SEQ ID NOs: 4 and 13-29. Each X outside the ring domain represents any amino acid or may be absent, or optionally represents any amino acid at the corresponding position in one of SEQ ID NOs: 4 and 13-29.

FIGS. 4A-4G are a multiple sequence alignment of various CNP homologs, in some cases including the N-terminal pre- and pro-sequences. The 17-amino acid ring domain for each NP is shown in bold and enclosed in a box. A consensus sequence (SEQ ID NO: 95) is shown below, wherein each X represents any amino acid, or optionally represents any amino acid at the corresponding position in one of SEQ ID NOs: 31-94.

FIG. 5 is a schematic diagram of the structure of a natriuretic peptide as described herein, which includes an optional N-terminal extension, an optional short segment, a required ring domain, and an optional C-terminal extension.

FIG. 6 is a listing of the amino acid sequence of an exemplary Fc from human IgG-1 (SEQ ID NO: 401).

FIGS. 7A-7E are schematic diagrams of exemplary Fc-NP or NP-Fc constructs. FIG. 7A depicts an Fc-NP dimer. FIG. 7B depicts an NP-Fc dimer. FIG. 7C depicts an Fc:Fc-NP monomer-dimer hybrid. FIG. 7D depicts an NP-Fc:Fc monomer-dimer hybrid. FIG. 7E depicts an NP-Fc:Fc-NP hybrid dimer.

FIG. 8A is a listing of the amino acid sequence of the immature NC2 Streptag (“NC2st”) fusion protein (SEQ ID NO: 501), together with a table providing a summary of protein regions. The N-terminal signal sequence, which is cleaved during translation, is underlined. Various linker sequences are shown in italics. The Fc domain is shown in bold. The CNP domain is shown in gray highlighting. FIG. 8B is a listing of the amino acid sequence of the NC2st fusion protein (SEQ ID NO: 502) without the signal sequence. FIG. 8C is a listing of the nucleic acid sequence (SEQ ID NO: 801) encoding the NC2st fusion protein.

FIG. 9 is a graph showing the results of a mouse study analyzing the non-compartmental pharmacokinetic parameters of NC2st following intravenous and subcutaneous administration to mice.

FIG. 10 is a graph showing the averaged results of 15 NPR-B whole cell dose-response assays for CNP and NC2st, together with a table showing average values for EC₅₀, EC₅₀ ratio relative to CNP, % efficacy, and % AUC. Also shown is a table showing levels of CNP required to achieve 50% and 100% achondroplasia phenotype correction (see, e.g., Yasoda et al., Endocrinology 150:3138-3144, 2009, hereby incorporated by reference), and projected corresponding levels of NC2st blood concentrations expected to achieve 50% and 100% achondroplasia phenotype correction.

FIG. 11 is a graph showing a dose regimen simulation for NC2st for two doses: 10 mg/kg twice daily, and 100 mg/kg twice daily.

FIGS. 12A-12H summarize the results of an efficacy study in Fgfr3^(369/+) mice. Each figure includes one or two charts showing the results of various measurements following necropsy, together with corresponding tables showing statistical analysis of the data. FIG. 12A shows the results of crown-rump length measurements following necropsy. FIG. 12B shows the results of tibia length measurements following necropsy. FIG. 12C shows the results of femur length measurements following necropsy. FIG. 12D shows the results of neck-anal length measurements following necropsy. FIG. 12E shows the results of cervical vertebrae length measurements following necropsy. FIG. 12F shows the results of thoracic vertebrae length measurements following necropsy. FIG. 12G shows the results of lumbar vertebrae length measurements following necropsy. FIG. 12H shows the results of sternum length measurements following necropsy.

FIG. 13 is a chart showing correlation between results of cGMP assays using serum spiked with NC2st (left) and serum from vehicle (Ve), wild-type (WT), Tx10 dosed mice, and Tx100 dosed mice (right).

FIG. 14 is a pair of charts showing the active concentrations of NC2st present in blood samples of mice in the Tx10 group (left) and Tx100 group (right).

FIG. 15A is a listing of the NC2B amino acid sequence, both with the signal sequence (SEQ ID NO: 503) and without the signal sequence (SEQ ID NO: 504), and the D10-NC2 amino acid sequence having a D₁₀ tag, both with the signal sequence (SEQ ID NO: 607) and without the signal sequence (SEQ ID NO: 608).

FIG. 15B is a listing of a nucleic acid sequence (SEQ ID NO: 802) encoding NC2B.

FIG. 16A is a listing of amino acid sequences for NC2B-22, NC2B-28, and NC2B-34, both with the signal sequence (SEQ ID NOs: 505, 507, and 509, respectively) and without the signal sequence (SEQ ID NOs: 506, 508, and 510, respectively). Signal sequences are underlined. The Fc domain is shown in bold. Linker sequences are shown in italics. The CNP domain is shown in gray highlighting. FIG. 16B is a listing of a nucleic acid sequence (SEQ ID NO: 803) encoding NC2B-22. FIG. 16C is a listing of a nucleic acid sequence (SEQ ID NO: 804) encoding NC2B-28. FIG. 16D is a listing of a nucleic acid sequence (SEQ ID NO: 805) encoding NC2B-34.

FIG. 17 is a graph showing the results of an NPR-B whole cell dose-response assay for CNP, NC2st, NC2B-22, NC2B-28, and NC2B-34, together with a table showing EC₅₀ values.

FIG. 18 is a listing of amino acid sequences for NC2-KGANKK and NC2-KGANQK, both with the signal sequence (SEQ ID NOs: 511 and 513, respectively) and without the signal sequence (SEQ ID NOs: 512 and 514, respectively). Signal sequences are underlined. The Fc domain is shown in bold. Linker sequences are shown in italics. The CNP domain is shown in gray highlighting.

FIG. 19 is a listing of amino acid sequences for NC2-CNP53mut2, both with the signal sequence (SEQ ID NO: 515) and without the signal sequence (SEQ ID NOs: 516). Signal sequence is underlined. The Fc domain is shown in bold. Linker sequences are shown in italics. The CNP domain is shown in gray highlighting.

FIG. 20 is a listing of amino acid sequences for Fc-CNP53-A (also referred to as Fc-CNP53 wt) and Fc-CNP53-AAA (also referred to as Fc-CNP53mut), both with the signal sequence (SEQ ID NOs: 517 and 519, respectively) and without the signal sequence (SEQ ID NOs: 518 and 520, respectively). Signal sequences are underlined. The Fc domain is shown in bold. Linker sequences are shown in italics. The CNP domain is shown in gray highlighting.

FIG. 21A is a set of dose-response curves for CNP, Fc-CNP53-A (also referred to as Fc-CNP53 wt), and Fc-CNP53-AAA (also referred to as Fc-CNP53mut) in an NPR-B membrane assay, together with a table showing EC₅₀ values, EC₅₀ ratios relative to CNP, % efficacy, and % AUC.

FIG. 21B is a set of dose-response curves for CNP, NC2st, Fc-CNP53-A, and Fc-CNP53-AAA in an NPR-B membrane assay, together with a table showing EC₅₀ values, EC₅₀ ratios relative to CNP, % efficacy, and % AUC.

FIG. 21C is a set of dose-response curves for CNP, NC2st, Fc-CNP53-A, and Fc-CNP53-AAA in an NPR-B whole cell assay, together with a table showing EC₅₀ values, EC₅₀ ratios relative to CNP, % efficacy, and % AUC.

FIG. 22 is a multiple sequence alignment of various NPs and homologs, including CDNP. The boxed region is the most conserved region of the DNP tail among NPRA-binding peptides. The sequences of numerous CDNP variants are shown in the bottom half of the figure, and a consensus sequence (SEQ ID NO: 118) for the DNP C-terminal tail is also shown. Each X in the consensus sequence represents any amino acid, or optionally represents any amino acid at the corresponding position in one of SEQ ID NOs: 100-116.

FIG. 23 is a graph showing the results of NEP degradation assays for CNP, CDNP, CDNP-N1, CDNP-K1, CDNP-H1, and CDNP-G1.

FIG. 24A is a set of dose-response curves for CDNP and several variants (CDNP-A4, CDNP-A5, CDNP-S3A4, CDNP-A4A5, CDNP-S3A5, and CDNP-S3A4A5) as tested in an NPR-B membrane assay. FIG. 24B is an additional set of dose-response curves for CDNP (tested twice), CDNP-S3A4, and CDNP-S3A4A5 as tested in an NPR-B membrane assay. FIG. 24C is a set of dose-response curves for CDNP and several variants (CDNP-A4, CDNP-A5, CDNP-S3A4, CDNP-A4A5, CDNP-S3A5, and CDNP-S3A4A5) as tested in an NPR-A membrane assay. FIG. 24D is an additional set of dose-response curves for CDNP (tested twice), CDNP-S3A4, and CDNP-S3A4A5 as tested in an NPR-A membrane assay.

FIG. 25 is a graph showing the results of NEP degradation assays for CNP and three variants (CDNP-S3A4A5 (CDNPsaa), CDNP-S3A5 (CDNPsra), and CDNP-S3A4 (CDNPsad)), together with a table showing the percent of intact molecule remaining after 180 minutes.

FIG. 26A is a listing of amino acid sequences for CNP-16AAlinker-Fc-His 10 (NC1) (SEQ ID NO: 521), CNP-6AAlinker-Fc-His10 (NC3) (SEQ ID NO: 522), CNP-6AAlinker-Fc (SEQ ID NO: 523), CDNP-Fc (SEQ ID NO: 524), CDNP-A17saa-Fc (SEQ ID NO: 525), and CDNP-A17sra-Fc (SEQ ID NO: 526). The CNP domain is shown in gray highlighting. Linker sequences are shown in italics. The Fc domain is shown in bold. FIG. 26B is a listing of the nucleic acid sequence (SEQ ID NO: 806) of NC1.

FIG. 27A is a set of dose-response curves for CNP, CDNP, and CDNP-Fc as tested in an NPR-B membrane assay, together with a table showing EC₅₀ values, EC₅₀ ratios relative to CNP, % efficacy, and % AUC. FIG. 27B is a set of dose-response curves for CNP and CDNP-Fc as tested in an NPR-B membrane assay, together with a table showing EC₅₀ values, EC₅₀ ratio relative to CNP, % efficacy, and % AUC. FIG. 27C is a set of dose-response curves for ANP, CNP, CDNP, and CDNP-Fc as tested in an NPR-A membrane assay, together with a table showing EC₅₀ values, EC₅₀ ratios relative to ANP, % efficacy, and % AUC.

FIG. 28A is a set of dose-response curves for CNP, CDNP-(A17)S3A4A5-Fc, and CDNP-(A17)S3A5-Fc as tested in a NPR-B whole cell cGMP assay, together with a table showing EC₅₀ values, EC₅₀ ratios relative to CNP, % efficacy, and % AUC. FIG. 28B is a set of dose-response curves for ANP, CDNP-(A17)S3A4A5-Fc, and CDNP-(A17)S3A5-Fc as tested in a NPR-A whole cell cGMP assay, together with a table showing EC₅₀ values, EC₅₀ ratios relative to ANP, % efficacy, and % AUC.

FIG. 29 is a listing of various point mutants (SEQ ID NOs: 119-125) each having a mutation at position 17 of CNP22, together with a consensus sequence (SEQ ID NO: 126). X represents any amino acid, or optionally represents any amino acid at the corresponding position in one of SEQ ID NOs: 119-125.

FIG. 30 is a set of dose-response curves for CNP and several variants (CNP—F17, CNP-L17, CNP-117, CNP-T17, and CNP-V17) as tested in a NPR-B whole cell cGMP assay, together with a table showing EC₅₀ and % efficacy values.

FIG. 31 is a listing of amino acid sequences for several CNP variants. The 17-amino acid ring domain for each variant is shown in bold. The linker region is shown in italics.

FIGS. 32A-32E are a listing of amino acid sequences for additional CNP variants.

FIGS. 33A-33Y summarize the results of an efficacy study in wild-type (CD-1) mice. Each figure includes one or two charts showing the results of various measurements in vivo or following necropsy, together with corresponding tables showing statistical analysis of the data. FIG. 33A shows the results of crown-rump length measurements in vivo over 36 study days. FIG. 33B shows the results of crown-rump length measurements in vivo at day 36. FIG. 33C shows the results of mean tail length measurements in vivo over 36 study days. FIG. 33D shows the results of mean tail length measurements in vivo at day 36. FIG. 33E shows the results of mean right tibia length measurements in vivo over 36 study days. FIG. 33F shows the results of mean right tibia length measurements in vivo at day 36. FIG. 33G shows the results of average body weight measurements in vivo over 36 study days. FIG. 33H shows the results of average body weight measurements in vivo at day 1 and day 36. FIG. 33I shows the results of left tibia length measurements following necropsy. FIG. 33J shows the results of left femur length measurements following necropsy. FIG. 33K shows the results of left ulna length measurements following necropsy. FIG. 33L shows the results of left humerus length measurements following necropsy. FIG. 33M shows the results of naso-anal length measurements following necropsy. FIG. 33N shows the ratio of naso-anal length measurements to crown rump length (CRL) measurements following necropsy. FIG. 33O shows the results of total cervical, thoracic, and lumbar (CTL) length measurements following necropsy. FIG. 33P shows the results of cervical vertebrae length measurements following necropsy. FIG. 33Q shows the results of thoracic vertebrae length measurements following necropsy. FIG. 33R shows the results of lumbar vertebrae length measurements following necropsy. FIG. 33S shows the results of sternum length measurements following necropsy. FIG. 33T shows radiographs of the feet and metatarsal bones following necropsy. FIG. 33U shows the results of metatarsal bone (third digit) length measurements following necropsy. FIG. 33V shows the results of foramen magnum height and width measurements following necropsy. FIG. 33W shows the ratio of foramen magnum width measurements to foramen magnum height measurements following necropsy. FIG. 33X shows the results of skull circularity index measurements following necropsy. FIG. 33Y shows the results of occipital-front distance measurements in the skull following necropsy.

FIG. 34 is a listing of amino acid sequences for CNP22 (SEQ ID NO: 4), CNP-L17 (SEQ ID NO: 120), CNP—F17 (SEQ ID NO: 119), CNP-T17 (SEQ ID NO: 122), D6-14AAlinker-CNP [C3] (SEQ ID NO: 147), CNP-14AAlinker-D6 [C4] (SEQ ID NO: 148), CNP-Nterm2 [C5] (SEQ ID NO: 150), CDNP—S3A4A5R6 [C13] (SEQ ID NO: 115), CDNP29-S3A4A5R6 [C14] (SEQ ID NO: 151), C1(E6) [BC1] (SEQ ID NO: 129), C2(E6) [BC2] (SEQ ID NO: 130), C3 (E6) [BC3] (SEQ ID NO: 131), C4(E6) [BC4] (SEQ ID NO: 132), C5(E6) [BC5] (SEQ ID NO: 133), C6(E6) [BC6] (SEQ ID NO: 134), C7(E6) [BC7] (SEQ ID NO: 135), C8(E6) [BC8] (SEQ ID NO: 136), C9(E6) [BC9] (SEQ ID NO: 137), C10(E6) [BC10] (SEQ ID NO: 138), C11(E6) [BC11] (SEQ ID NO: 139), PGCNP37(E6) (SEQ ID NO: 128), KA1 (SEQ ID NO:152), KA1(E6) (SEQ ID NO:153), KB1 (SEQ ID NO:154), and KB1(E6) (SEQ ID NO: 155). The 17-amino acid ring domain for each variant is shown in bold. The linker sequences are shown in italics. The cathepsin cleavage sequences are shown in underline.

FIG. 35A is a graph showing the results of NEP degradation assays for CNP22, D6-14AAlinker-CNP [C3], CNP-14AAlinker-D6 [C4], CNP-Nterm2 [C5], CDNP—S3A4A5R6 [C13], CDNP29-S3A4A5R6 [C14], KB1(E6), C2(E6), and C3(E6), where these sequences are shown in FIG. 34.

FIG. 35B is a graph showing the results of NEP degradation assays for CNP22, KA1(E6), C1(E6), and C4(E6)-C11(E6), where these sequences are shown in FIG. 34.

FIG. 36A is a graph showing the result of NEP degradation assays for CNP22, NC2-KGANKK, NC2B-L17, and NC2-KGANKK-L17 (NC2-KL).

FIG. 36B is a graph showing the result of IDE degradation assays for CNP22, NC2-KGANKK, NC2B-L17, and NC2-KGANKK-L17 (NC2-KL).

FIG. 37A is a set of dose-response curves for NC2-CNP53mut2, NC2-KGANKK, and NC2-KGANQK in an NPR-B whole cell assay, together with a table showing EC₅₀ values, EC₅₀ ratios relative to CNP22, % efficacy, and rescue range with rescue ratio relative to CNP22.

FIG. 37B is a set of dose-response curves for NC2B, and NC2B-L17 in an NPR-B whole cell assay, together with a table showing EC₅₀ values, EC₅₀ ratios relative to CNP22, % efficacy, and rescue range with rescue ratio relative to CNP22.

FIG. 38 is a listing of amino acid sequences for CNP variants having a point mutation at position 17 relative to CNP22 (SEQ ID NOs: 126, 119-122, and 156-172). For SEQ ID NOs: 126 and 162, X can be any amino acid, including but not limited to F, L, I, T, E, R, Y, C, P, or D. The 17-amino acid ring domain for each variant is shown in bold. The linker sequences are shown in italics.

FIGS. 39A-39B are listings of amino acid sequences for additional CNP variants having a point mutation at position 17 relative to CNP22 (SEQ ID NOs: 173-220). X can be any amino acid, including but not limited to F, L, I, T, E, R, Y, C, P, or D. The 17-amino acid ring domain for each variant is shown in bold. The linker sequences are shown in italics. The cathepsin cleavage sequences are shown in underline.

FIG. 40 is a listing of amino acid sequences for CNP variants having a point mutation at position 17 relative to CNP22, where the methionine at position 17 has been substituted with a leucine (SEQ ID NOs: 221-233). The 17-amino acid ring domain for each variant is shown in bold. The linker sequences are shown in italics. The cathepsin cleavage sequences are shown in underline.

FIGS. 41A-41E are listings of amino acid sequences for constructs having a point mutation at position 17 relative to CNP22 (SEQ ID NOs: 527-552). X can be any amino acid, including but not limited to F, L, I, T, E, R, Y, C, P, or D. Signal sequences are underlined. The Fc domain is shown in bold. Linker sequences are shown in italics. The CNP domain is shown in gray highlighting.

FIG. 42A-42J are listings of amino acid sequences for NC2 variants (SEQ ID NOs: 511-516 and 553-606) with or without the signal sequence and either with or without a D₁₀ bone-targeting moiety at the N-terminal. Signal sequences are underlined. The Fc domain is shown in bold. Linker sequences are shown in italics. The CNP domain is shown in gray highlighting.

FIGS. 43A-43C show NC2B hemodynamic dose-response effects by providing average changes of systolic arterial blood pressure (A), diastolic arterial blood pressure (B), and mean arterial blood pressure (C) observed between 2 to 8 hours post-subcutaneous administration, relative to an average baseline obtained 30 minutes prior to injection. Analysis is based on average telemetry data pooled from the 5 consecutive injection days for each individual mice; n=6 per group.

FIGS. 44A-44B provide the results at day 36 of a weekly dosing regimen study for NC2B in wild-type mice. FIG. 44A shows the results of naso-anal length measurements following necropsy. FIG. 44B shows the results of humerus (left graph) and femur (right graph) length measurements following necropsy.

DETAILED DESCRIPTION

The present invention features natriuretic peptides, e.g., fused to an Fc domain of an immunoglobulin, nucleic acid molecules encoding such polypeptides, and their uses to treat disorders associated with overactivation of FGFR3, bone or cartilage disorders (e.g., achondroplasia), vascular smooth muscle disorders, as well as to elongate bone. Additional details of the invention are provided below.

NPs

Any natriuretic peptide or variant thereof that is an agonist of natriuretic peptide receptor B (“NPR-B”), e.g., human NPR-B, may be used in any of the methods and compositions described herein.

Natriuretic peptides as described herein are peptides that are capable of agonizing NPR-B. Natriuretic peptides, including CNP, which primarily agonizes NPR-B, and ANP and BNP, which primarily agonize NPR-A, have important roles in multiple biological processes. Multiple sequence alignments of various NP family members and consensus sequences are shown in FIGS. 1-3 and 4A-4G.

A key downstream effect of CNP22 and CNP53, and variants thereof as described herein, in agonizing NPR-B is endochondral ossification. Thus, the NPs described herein are useful, e.g., for treating a wide array of disorders associated with overactivation of FGFR3 and vascular smooth muscle disorders.

NPs include the schematic structure shown in FIG. 5, wherein the ring domain is required and each of the N-terminal extension, short segment, and C-terminal extension is optional. The ring domain is 17 amino acids long, with cysteine residues at each terminus of the ring domain (positions 1 and 17) that form a disulfide bond. In some embodiments, the ring domain has an amino acid sequence that falls within one of the consensus sequences shown in FIG. 1, 3, or 4A-4G (SEQ ID NO: 6, amino acids 11-27 of SEQ ID NO: 30, or SEQ ID NO: 95, respectively). Any of the ring domains shown in FIGS. 1-3 and 4A-4G may be used in an NP as described herein.

The short segment is a segment immediately N-terminal to the ring domain that is between 0 and 10 amino acids (e.g., 0, 1, 2, 3, 4, 5, 6, 7, 8, 9, or 10 amino acids) in length. Exemplary short segments are shown immediately N-terminal to the boxed region in FIG. 1 or FIG. 3, e.g., residues 1-5 of SEQ ID NO: 4, or the 1, 2, 3, 4, 5, 6, 7, 8, 9, or 10 amino acids immediately N-terminal to the conserved ring domain in any of the species shown in FIGS. 3 and 4A-4G. In some embodiments, the short segment consists of the 5-amino acid portion immediately N-terminal to the conserved ring domain in any of the species shown in FIG. 1, 3, or 4A-4G. In some embodiments, the short segment confers increased selectivity for NPR-B relative to NPR-A.

The N-terminal extension is a region immediately N-terminal to the short segment (if the short segment is present) or the ring domain (if the short segment is not present) and may be of any length, e.g., 0, 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38, 39, 40, 41, 42, 43, 44, 45, 46, 47, 48, 49, 50, 55, 60, 65, 70, 75, 80, 85, 90, 95, 100, 125, 150, 175, 200, 250, 300, 350, 400, 450, 500, or even more amino acids. This region is absent in CNP22 but is present in CNP53 (residues 1-31 of SEQ ID NO: 11). Exemplary N-terminal extensions are the 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38, 39, 40, 41, 42, 43, 44, 45, 46, 47, 48, 49, 50, 51, 52, 53, 54, 55, 56, 57, 58, 59, 60, 61, 62, 63, 64, 65, 66, 67, 68, 69, 70, 71, 72, 73, 74, 75, 76, 77, 78, 79, 80, 81, 82, 83, 84, 85, 86, 87, 88, 89, 90, 91, 92, 93, 94, 95, 96, 97, 98, 99, 100, 110, 120, 130, 140, 150, 160, 170, 180, 190, 200, 225, 250, or more residues immediately N-terminal to the short segment, e.g., of 5 amino acids (if short segment is present), or immediately N-terminal to the ring domain (if short segment is not present), of any of the species shown in FIGS. 4A-4G. In some embodiments, the N-terminal extension provides increased selectivity for NPR-B relative to NPR-A.

The C-terminal extension is a region immediately C-terminal to the ring domain and may be of any length, e.g., 0, 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38, 39, 40, 41, 42, 43, 44, 45, 46, 47, 48, 49, 50, 55, 60, 65, 70, 75, 80, 85, 90, 95, 100, 125, 150, 175, 200, 250, 300, 350, 400, 450, 500, or even more amino acids. This region is absent in CNP22 and CNP53 but is present in the hybrid peptide CDNP (SEQ ID NO: 100). Exemplary C-terminal extensions are shown immediately C-terminal to the boxed region in FIG. 1, e.g., amino acids 24-28 of SEQ ID NO: 1, amino acids 28-32 of SEQ ID NO: 2, amino acids 27-32 of SEQ ID NO: 3, or amino acids 24-38 of SEQ ID NO: 5. In some embodiments, the C-terminal tail includes, or consists of, the DNP C-terminal tail (SEQ ID NO: 117), or a variant thereof having one or more addition, deletion, or substitution mutations (e.g., SEQ ID NO: 118). For example, a C-terminal tail of an NP may include any of the DNP C-terminal tail mutations shown in FIG. 22. In particular, residues 1, 3, 4, 5, 6, and/or 7 of the DNP C-terminal tail (SEQ ID NO: 117) may be mutated, e.g., as in any of the mutations shown in FIG. 22. In some embodiments, the C-terminal extension confers increased selectivity for NPR-B relative to NPR-A.

An NP may optionally be glycosylated at any appropriate one or more amino acid residues.

In addition, an NP may have at least 50% (e.g., 55%, 60%, 65%, 70%, 75%, 80%, 81%, 82%, 83%, 84%, 85%, 86%, 87%, 88%, 89%, 90%, 91%, 92%, 93%, 94%, 95%, 96%, 97%, 98%, 99%, or more) sequence identity to any of the NPs described herein, or to one or more of the ring domain, the short segment, the C-terminal extension, or the N-terminal extension.

An NP may have 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, or more additions, deletions, or substitutions relative to any of the NPs described herein, or to one or more of the ring domain, the short segment, the C-terminal extension, or the N-terminal extension.

An NP as described herein may include any other sequence or moiety, attached covalently or non-covalently, provided that the NP has the ability to agonize NPR-B.

In some embodiments, an NP as described herein may be no more than 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38, 39, 40, 41, 42, 43, 44, 45, 46, 47, 48, 49, 50, 51, 52, 53, 54, 55, 56, 57, 58, 59, 60, 70, 80, 90, 100, 110, or 120 amino acids in length. Furthermore, in some embodiments, an NP as described herein may be no more than 1.8, 2.0, 2.2, 2.4, 2.6, 2.8, 3.0, 3.2, 3.4, 3.6, 3.8, 4.0, 4.2, 4.4, 4.6, 4.8, 5.0, 5.2, 5.4, 5.6, 5.8, 6.0, 6.2, 6.4, 6.6, 6.8, 7.0, 7.2, 7.4, 7.6, 7.8, 8.0, 8.2, 8.4, 8.6, 8.8, 9.0, 9.2, 9.4, 9.6, 9.8, or 10.0 kilodaltons (kDa) in molecular weight.

NPs that are suitable for use in the compositions and methods described herein include those described, e.g., in U.S. Pat. Nos. 5,352,770; 5,434,133; 6,020,168; 6,034,231; 6,407,211; 6,743,425; 6,818,619; 7,276,481; 7,384,917; and 7,754,852; U.S. Application Pub. Nos. 2007-0197434; 2008-0181903; 2008-0312142; 2009-0170756; 2010-0055150; and 2010-0297021; International Application Pub. Nos. WO 94/20534; WO 02/047871; WO 2004/047871; WO 2005/098490; WO 2008/154226; and WO 2009/067639; European Application Pub. Nos. EP 0497368 and EP 0466174; Furuya et al., Biochem. Biophys. Res. Comm. 183: 964-969 (1992); Takano et al., Zool. Sci., 11: 451-454 (1994); Plater et al., Toxicon., 36(6): 847-857 (1998); and Inoue et al., Proc. Nat. Acad. Sci., 100(17): 10079-10084 (2003), each of which is hereby incorporated by reference in its entirety, including all formulas, structures, and sequences for natriuretic peptides and variants thereof. In alternative embodiments, the NPs referenced in the present paragraph are excluded from the compositions and methods described herein.

In some embodiments, any of the NPs described or incorporated by reference herein may be used in the compositions and methods described herein without fusion to an Fc domain or to a linker, or alternatively may be fused to any of the linkers described herein but not to an Fc domain. Such NPs may be used to treat a disorder associated with overactivation of FGFR3, e.g., achondroplasia, or a vascular smooth muscle disorder, as described herein.

In other embodiments, any of the NPs described or incorporated by reference herein may include a point mutation at position 17 relative to CNP22. Wild-type CNP22 has a methionine at position 17 relative to CNP22, which can be oxidized in vivo and/or which can provide a peptide that is degradable by a protease. As described herein, point mutations at position 17 relative to CNP22 could provide polypeptides having decreased degradation, while maintaining potency. Exemplary amino acids at position 17 relative to CNP22 are Phe, Leu, Ile, Thr, Glu, Arg, Tyr, Cys, Pro, Asp, Gly, Ala, Ser, Val, Trp, Asn, Gln, His, or Lys, e.g., Phe, Leu, Ile, Thr, Glu, Arg, Tyr, Cys, Pro, or Asp, e.g., Phe or Leu, e.g., Leu. For example, the amino acid at position 17 relative to CNP22 could be Phe, Leu, Ile, Thr, Glu, Arg, Tyr, Cys, Pro, and Asp, e.g., Phe or Leu, e.g., Leu. In another example, the amino acid at position 17 relative to CNP22 could be Phe, Leu, Ile, Thr, Val, Ala, or Ser. Alternatively, exemplary amino acids at position 17 relative to CNP22 are Gly, Ala, Ser, Val, Trp, Asn, Gln, His, or Lys.

Furthermore, included in the compositions and methods described herein are nucleic acid molecules encoding any of the NPs and fusion polypeptides described herein, as well as nucleic acid molecules that hybridize under high stringency conditions to at least a portion, e.g., to 20%, 30%, 40%, 50%, 60%, 70%, 75%, 80%, 85%, 90%, 95%, 96%, 97%, 98%, 99%, or even 100%, of a nucleic acid molecule that encodes any of the NPs or fusion polypeptides described herein.

Fragment Crystallizable Region (Fc) Fragments

The fusion polypeptides of the invention may include an N-terminal or C-terminal domain such as Fc, a fragment crystallizable region of an immunoglobulin. An immunoglobulin molecule has a structure that is well known in the art. It includes two light chains (˜23 kD each) and two heavy chains (˜50-70 kD each) joined by inter-chain disulfide bonds. Immunoglobulins are readily cleaved proteolytically (e.g., by papain cleavage) into Fab (containing the light chain and the VII and CH1 domains of the heavy chain) and Fc (containing the C_(H2) and C_(H3) domains of the heavy chain, along with adjoining sequences). Cleavage typically occurs in a flexible hinge region joining the Fab and Fc regions. For example, papain cleaves the hinge region immediately before the disulfide bonds joining the two heavy chains.

Useful Fc fragments as described herein include the Fc fragment of any immunoglobulin molecule, including IgG, IgM, IgA, IgD, or IgE, and their various subclasses (e.g., IgG-1, IgG-2, IgG-3, IgG-4, IgA-1, IgA-2), taken from any mammal (e.g., human). The Fc fragments of the invention may include, for example, the C_(H2) and C_(H3) domains of the heavy chain, as well as any portion of the hinge region. Furthermore, the Fc region may optionally be glycosylated at any appropriate one or more amino acid residues, e.g., various amino acid residues known to those skilled in the art. In some embodiments, the Fc fragment is of human IgG-1. In particular embodiments, the Fc fragment of the fusion polypeptide has the amino acid sequence of SEQ ID NO: 401, or has at least 50% (e.g., 55%, 60%, 65%, 70%, 75%, 80%, 81%, 82%, 83%, 84%, 85%, 86%, 87%, 88%, 89%, 90%, 91%, 92%, 93%, 94%, 95%, 96%, 97%, 98%, 99%, or more) sequence identity to SEQ ID NO: 401 (FIG. 6).

In some embodiments, engineered, e.g., non-naturally occurring, Fc regions may be utilized in the compositions and methods of the invention, e.g., as described in International Application Pub. No. WO2005/007809, which is hereby incorporated by reference.

An Fc fragment as described herein may have 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 25, 30, 35, 40, 50, or more additions, deletions, or substitutions relative to any of the Fc fragments described herein.

Linkers

The fusion proteins described herein may include a peptide linker region between the Fc fragment and the NP. The linker region may be of any sequence and length that allows the NP to remain biologically active, e.g., not sterically hindered. Exemplary linker lengths are between 1 and 200 amino acids, e.g., 1-5, 6-10, 11-15, 16-20, 21-25, 26-30, 31-35, 36-40, 41-45, 46-50, 51-55, 56-60, 61-65, 66-70, 71-75, 76-80, 81-85, 86-90, 91-95, 96-100, 101-110, 111-120, 121-130, 131-140, 141-150, 151-160, 161-170, 171-180, 181-190, or 191-200 amino acids. Additional exemplary linker lengths are 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38, 39, 40, 41, 42, 43, 44, 45, 46, 47, 48, 49, 50, 51, 52, 53, 54, 55, 56, 57, 58, 59, 60, 61, 62, 63, 64, 65, 66, 67, 68, 69, 70, 71, 72, 73, 74, 75, 76, 77, 78, 79, 80, 81, 82, 83, 84, 85, 86, 87, 88, 89, 90, 91, 92, 93, 94, 95, 96, 97, 98, 99, 100, 110, 120, 130, 140, 150, 160, 170, 180, 190, or 200 amino acids. Additional exemplary linker lengths are 14-18, 20-24, 26-30, 32-36, 38-42, and 44-48 amino acids.

In some embodiments, linkers include or consist of flexible portions, e.g., regions without significant fixed secondary or tertiary structure. Exemplary flexible linkers are glycine-rich linkers, e.g., containing at least 50%, 60%, 65%, 70%, 75%, 80%, 85%, 90%, 95%, or even 100% glycine residues. Linkers may also contain, e.g., serine residues. In some cases, the amino acid sequence of linkers consists only of glycine and serine residues.

In some cases, the amino acid sequence of the linker sequence includes or consists of a sequence according to the formula [(Gly)_(m)(Ser)]_(n)(Gly)_(p), where each of m, n, and p is, independently, 0, 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, or 20. In some embodiments, m=1, 2, 3, 4, 5, or 6; n=1, 2, 3, 4, 5, 6, 7, 8, 9, or 10; and p=0, 1, 2, 3, or 4. Alternatively, the linker sequence includes or consists of a sequence according to the formula (Gly)_(p)[(Ser)(Gly)_(m)]_(n), where each of m, n, and p is, independently, 0, 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, or 20. In some embodiments, m=1, 2, 3, 4, 5, or 6; n=1, 2, 3, 4, 5, 6, 7, 8, 9, or 10; and p=0, 1, 2, 3, or 4.

Exemplary combinations of m, n, and p values for either of the preceding two formulae are listed in Table 1.

TABLE 1 m n p N/A 0 1 N/A 0 2 N/A 0 3 N/A 0 4 N/A 0 5 N/A 0 6 N/A 0 7 N/A 0 8 N/A 0 9 N/A 0 10 1 1 0 1 2 0 1 3 0 1 4 0 1 5 0 1 6 0 1 7 0 1 8 0 1 9 0 1 10 0 2 1 0 2 2 0 2 3 0 2 4 0 2 5 0 2 6 0 2 7 0 2 8 0 2 9 0 2 10 0 3 1 0 3 2 0 3 3 0 3 4 0 3 5 0 3 6 0 3 7 0 3 8 0 3 9 0 3 10 0 4 1 0 4 2 0 4 3 0 4 4 0 4 5 0 4 6 0 4 7 0 4 8 0 4 9 0 4 10 0 5 1 0 5 2 0 5 3 0 5 4 0 5 5 0 5 6 0 5 7 0 5 8 0 5 9 0 5 10 0 6 1 0 6 2 0 6 3 0 6 4 0 6 5 0 6 6 0 6 7 0 6 8 0 6 9 0 6 10 0 1 1 1 1 2 1 1 3 1 1 4 1 1 5 1 1 6 1 1 7 1 1 8 1 1 9 1 1 10 1 2 1 1 2 2 1 2 3 1 2 4 1 2 5 1 2 6 1 2 7 1 2 8 1 2 9 1 2 10 1 3 1 1 3 2 1 3 3 1 3 4 1 3 5 1 3 6 1 3 7 1 3 8 1 3 9 1 3 10 1 4 1 1 4 2 1 4 3 1 4 4 1 4 5 1 4 6 1 4 7 1 4 8 1 4 9 1 4 10 1 5 1 1 5 2 1 5 3 1 5 4 1 5 5 1 5 6 1 5 7 1 5 8 1 5 9 1 5 10 1 6 1 1 6 2 1 6 3 1 6 4 1 6 5 1 6 6 1 6 7 1 6 8 1 6 9 1 6 10 1 1 1 2 1 2 2 1 3 2 1 4 2 1 5 2 1 6 2 1 7 2 1 8 2 1 9 2 1 10 2 2 1 2 2 2 2 2 3 2 2 4 2 2 5 2 2 6 2 2 7 2 2 8 2 2 9 2 2 10 2 3 1 2 3 2 2 3 3 2 3 4 2 3 5 2 3 6 2 3 7 2 3 8 2 3 9 2 3 10 2 4 1 2 4 2 2 4 3 2 4 4 2 4 5 2 4 6 2 4 7 2 4 8 2 4 9 2 4 10 2 5 1 2 5 2 2 5 3 2 5 4 2 5 5 2 5 6 2 5 7 2 5 8 2 5 9 2 5 10 2 6 1 2 6 2 2 6 3 2 6 4 2 6 5 2 6 6 2 6 7 2 6 8 2 6 9 2 6 10 2 1 1 3 1 2 3 1 3 3 1 4 3 1 5 3 1 6 3 1 7 3 1 8 3 1 9 3 1 10 3 2 1 3 2 2 3 2 3 3 2 4 3 2 5 3 2 6 3 2 7 3 2 8 3 2 9 3 2 10 3 3 1 3 3 2 3 3 3 3 3 4 3 3 5 3 3 6 3 3 7 3 3 8 3 3 9 3 3 10 3 4 1 3 4 2 3 4 3 3 4 4 3 4 5 3 4 6 3 4 7 3 4 8 3 4 9 3 4 10 3 5 1 3 5 2 3 5 3 3 5 4 3 5 5 3 5 6 3 5 7 3 5 8 3 5 9 3 5 10 3 6 1 3 6 2 3 6 3 3 6 4 3 6 5 3 6 6 3 6 7 3 6 8 3 6 9 3 6 10 3 1 1 4 1 2 4 1 3 4 1 4 4 1 5 4 1 6 4 1 7 4 1 8 4 1 9 4 1 10 4 2 1 4 2 2 4 2 3 4 2 4 4 2 5 4 2 6 4 2 7 4 2 8 4 2 9 4 2 10 4 3 1 4 3 2 4 3 3 4 3 4 4 3 5 4 3 6 4 3 7 4 3 8 4 3 9 4 3 10 4 4 1 4 4 2 4 4 3 4 4 4 4 4 5 4 4 6 4 4 7 4 4 8 4 4 9 4 4 10 4 5 1 4 5 2 4 5 3 4 5 4 4 5 5 4 5 6 4 5 7 4 5 8 4 5 9 4 5 10 4 6 1 4 6 2 4 6 3 4 6 4 4 6 5 4 6 6 4 6 7 4 6 8 4 6 9 4 6 10 4

In some embodiments, the amino acid sequence of the linker includes or consists of a sequence in Table 2.

TABLE 2 Linker sequence SEQ ID NO. G 301 GG 302 GGG 303 GGGG 304 GGGGS 305 GGGGSG 306 GGGGSGGGGSGGGG 307 GGGGSGGGGSGGGGSG 308 GGGGSGGGGSGGGGSGGGGSGG 309 GGGGSGGGGSGGGGSGGGGSGGGGSGGG 310 GGGGSGGGGSGGGGSGGGGSGGGGSGGGGSGGGG 311 GGGGSGGGGSGGGGSGGGGSGGGGSGGGGSGGGGSGGGGS 312 GGGGSGGGGSGGGGSGGGGSGGGGSGGGGSGGGGSGGGGSGGGGSG 313 KGANKK 314 KGANQK 315 KGANKQ 316 KGANQQ 317 QGANKK 318 QGANQK 319 QGANKQ 320 QGANQQ 321 GGGGSGGGGSKGANKK 322 GGGGSGGGGSKGANQK 323 GGGGSGGGGSKGANKQ 324 GGGGSGGGGSKGANQQ 325 GGGGSGGGGSQGANKK 326 GGGGSGGGGSQGANQK 327 GGGGSGGGGSQGANKQ 328 GGGGSGGGGSQGANQQ 329 GGGDLQVDTQSQAAWAQLLQEHPNAQQYKGANKK 330 GGGGSGGGGSGGGGSGGGGSGGGGSGGGKGANKK 331 GGGGSGGGGSGGGGSGGGGSGGGGSGGGKGANQK 332 GGGGSGGGGSGGGGSGGGGSGGGGSGGGQGANQQ 333 QEHPNARKYKGANKK 334 GQEHPNARKYKGANKK 335 PGQEHPNARKYKGANKK 336 SGGGGSGGGGSGGGG 337 ASTSPANPQPAASSP 338 PSSAAPQPNAPSTSA 339 SGGGGSGGGKGANKK 340 SGGGGSGGGQGANQQ 341 SGGGGSGGGKGANKQ 342 SGGGGSGGGKGANQK 343 SGGGGSGGGQGANKK 344 SGGGGSGGGKGANQQ 345 SGGGGSGGGQGANQK 346 SGGGGSGGGQGANKQ 347 ASTSPANPQPAASSG 348 GSSAAPQPNAPSTSA 349 GSSAAPRPNAPSTSAGLSKG 350 ASTSPANPRPAASSG 351 HGPQGQEHPNARKYKGANKK 352 HKLRGQEHPNARKYKGANKK 353 GHGPQGQEHPNARKYKGANKK 354 GHKLRGQEHPNARKYKGANKK 355 GGHGPQGQEHPNARKYKGANKK 356 GGHKLRGQEHPNARKYKGANKK 357 GGGHGPQGQEHPNARKYKGANKK 358 GGGHKLRGQEHPNARKYKGANKK 359 GGGGHGPQGQEHPNARKYKGANKK 360 GGGGHKLRGQEHPNARKYKGANKK 361 GGGGGHGPQGQEHPNARKYKGANKK 362 GGGGGHKLRGQEHPNARKYKGANKK 363 HGPQGSGGGGSGGGKGANKK 364 HKLRGSGGGGSGGGKGANKK 365 GGGHGPQGSGGGGSGGGKGANKK 366 GGGHKLRGSGGGGSGGGKGANKK 367 SGGGGQEHPNARKYKGANKK 368 GGGSGGGGQEHPNARKYKGANKK 369 SGGGGSGGGGSGGGKGANKK 370 SGGGGSGGGGSGGGGSGGGKGANKK 371 GGGSGGGGSGGGGSGGGKGANKK 372 GGGSGGGGSGGGGSGGGGSGGGKGANKK 373 HGPQG 374 HKLRG 375 GHGPQG 376 GGHGPQG 377 GGGHGPQG 378 GGGGHGPQG 379 GGGGGHGPQG 380 GHKLRG 381 GGHKLRG 382 GGGHKLRG 383 GGGGHKLRG 384 GGGGGHKLRG 385 GGQEHPNARKYKGANKK 386 GGGQEHPNARKYKGANKK 387 GGGGQEHPNARKYKGANKK 388 GGGGGQEHPNARKYKGANKK 389

In some embodiments, the linker may include or consist of a [(Gly)_(m)(Ser)]_(n)(Gly)_(p) or (Gly)_(p)[(Ser)(Gly)_(m)]_(n) linker as described above, followed by one of SEQ ID NOs: 314-321, e.g., one of SEQ ID NOs: 314, 315, or 321.

In other embodiments, the linker may include or consist of all or a fragment of an NP. For example, the 31-amino acid portion of human CNP53 that is N-terminal to CNP22, or homologs or variants thereof (e.g., residues 4-34 of SEQ ID NO: 320), may be used as a linker. Homologs of this 31-amino acid region may be identified, e.g., by consulting a sequence alignment such as FIGS. 4A-4G and identifying the regions corresponding to the N-terminal 31 amino acids of human CNP53. Other suitable linkers may also be identified, e.g., by choosing any portion of an NP, optionally excluding a ring domain, as shown in FIGS. 4A-4G, or in any other NP or region of an NP not shown in FIGS. 4A-4G. For example, the C-terminal extension of DNP (SEQ ID NO: 117), or fragments or variants thereof, may be used as a linker.

A linker may optionally be glycosylated at any appropriate one or more amino acid residues.

In addition, a linker may have at least 50% (e.g., 55%, 60%, 65%, 70%, 75%, 80%, 81%, 82%, 83%, 84%, 85%, 86%, 87%, 88%, 89%, 90%, 91%, 92%, 93%, 94%, 95%, 96%, 97%, 98%, 99%, or more) sequence identity to any of the linkers described herein. In addition, a linker may have 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, or more additions, deletions, or substitutions relative to any of the linkers described herein.

A linker as described herein may include any other sequence or moiety, attached covalently or non-covalently.

In some embodiments, the linker is absent, meaning that the Fc fragment and the NP are fused together directly, with no intervening residues.

It should be noted that certain Fc-NP or NP-Fc fusion proteins may be viewed, according to the present disclosure, either as 1) having no linker, or as 2) having a linker which corresponds to a portion of the NP. For example, Fc fused directly to CNP53 may be viewed, e.g., either as having no linker, wherein the NP is CNP53, or as having a 31-amino acid linker, wherein the NP is CNP22.

Fusion Polypeptides

Any of the NPs, linkers, and Fc regions described herein may be combined in a fusion polypeptide, e.g., a recombinant fusion polypeptide, that includes the structure X-Fc-Y—NP-Z or the structure X—NP—Y-Fc-Z, wherein each of X, Y (the linker region), and Z is absent or is an amino acid sequence of at least one amino acid.

FIGS. 7A-7E depict several possible schematic structures of fusion polypeptides as described herein. Fc-NP or NP-Fc homodimers may be formed, e.g., due to disulfide bonds formed by Fc (FIGS. 7A and 7B, respectively). Alternative, monomer-dimer hybrids are possible in which an NP-Fc or Fc-NP fusion polypeptide is joined to a free Fc domain (FIGS. 7C and 7D, respectively). Furthermore, an NP-Fc monomer may be joined to an Fc-NP monomer, as shown in FIG. 7E. These configurations not intended to be exhaustive but are merely exemplary.

X may include one or more (e.g., 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 25, 30, 35, 40, 45, 50, or more) additional amino acids at the N-terminus of the polypeptide, and Z may independently include one or more (e.g., 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 25, 30, 35, 40, 45, 50, or more) additional amino acids at the C-terminus of the polypeptide.

In some embodiments, the polypeptide includes a bone-targeting moiety, e.g., having a series of consecutive Asp or Glu residues, e.g., E₆, E₇, E₈, E₉, E₁₀, E₁₁, E₁₂, E₁₃, E₁₄, E₁₅, E₁₆, D₆, D₇, D₈, D₉, D₁₀, D₁₁, D₁₂, D₁₃, D₁₄, D₁₅, or D₁₆. The bone-targeting moiety, if present, may be positioned anywhere in the fusion polypeptide, e.g., at or near the N-terminal or C-terminal end, and/or in the linker region. For example, any one of X, Y, and/or Z may include a bone-targeting moiety.

In some instances, one or more amino acids are introduced into the fusion polypeptide, e.g., within X, Y, or Z, as a result of the cloning strategy used. In some embodiments, any such additional amino acids, when incorporated into the polypeptide of the invention, do not provide a cleavage site for endoproteases of the host cell. The likelihood that a designed sequence would be cleaved by the endoproteases of the host cell can be predicted as described, e.g., by Ikezawa (Biol. Pharm. Bull. 25:409-417, 2002), hereby incorporated by reference.

The polypeptides of the invention also include any polypeptide having one or more post-translational modifications such as glycosylation (e.g., mannosylation and other forms of glycosylation discussed herein), acetylation, amidation, blockage, formylation, gamma-carboxyglutamic acid hydroxylation, methylation, ubiquitination, phosphorylation, pyrrolidone carboxylic acid modification, and sulfation. Artificial modifications, e.g., pegylation, may also be made.

In certain embodiments, the fusion polypeptides of the invention are associated into dimers, e.g., through two disulfide bonds located in the hinge regions of the Fc fragments.

In some embodiments, the fusion polypeptides of the invention have at least, e.g., 1, 1.5, 2, 2.5, 3, 3.5, 4, 5, 6, 7, 8, 9, 10, 12.5, 15, 20, 25, 30, 35, 40, 45, 50, 75, 100, 125, 150, 175, 200, 250, 300, 350, 400, 450, 500, 600, 700, 800, 900, 1,000, 1,500, 2,000, 3,000, 4,000, 5,000, 7,500, 10,000, 15,000, 20,000, 25,000, 30,000, 40,000, or 50,000 times the half-life of CNP22 in vivo.

Any NP fusion protein may be expressed with an N-terminal signal sequence to facilitate secretion, e.g., amino acids 1-25 of SEQ ID NO: 501, or any other signal sequence known in the art. Such sequences are generally cleaved co-translationally, resulting in secretion of the mature version of the protein.

A fusion polypeptide as described herein may have at least 50% (e.g., 55%, 60%, 65%, 70%, 75%, 80%, 81%, 82%, 83%, 84%, 85%, 86%, 87%, 88%, 89%, 90%, 91%, 92%, 93%, 94%, 95%, 96%, 97%, 98%, 99%, or more) sequence identity to any of the fusion polypeptides described herein, e.g., SEQ ID NOs: 501-608. In addition, a fusion polypeptide as described herein may have 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 25, 30, 35, 40, 50, or more additions, deletions, or substitutions relative to any of the fusion polypeptides described herein. Furthermore, in some embodiments, a fusion polypeptide as described herein may be encoded by a nucleic acid molecule that hybridizes under high stringency conditions to at least a portion, e.g., to 20%, 30%, 40%, 50%, 60%, 70%, 75%, 80%, 85%, 90%, 95%, 96%, 97%, 98%, 99%, or even 100%, of a nucleic acid molecule that encodes any of the polypeptides, e.g., fusion polypeptides, described herein.

Production of Nucleic Acids and Polypeptides

The nucleic acids and polypeptides of the invention can be produced by any method known in the art. Typically, a nucleic acid encoding the desired fusion protein is generated using molecular cloning methods, and is generally placed within a vector, such as a plasmid or virus. The vector is used to transform the nucleic acid into a host cell appropriate for the expression of the fusion protein. Representative methods are disclosed, for example, in Maniatis et al. (Cold Springs Harbor Laboratory, 1989). Many cell types can be used as appropriate host cells, although mammalian cells are preferable because they are able to confer appropriate post-translational modifications. For example, Human Embryonic Kidney 293 (HEK293) cells have been used as a host for expressing the fusion proteins of the present invention, as described in more detail in the Examples below.

The polypeptides of the invention can be produced under any conditions suitable to effect expression of the polypeptide in the host cell. Such conditions include appropriate selection of a media prepared with components such as a buffer, bicarbonate and/or HEPES, ions like chloride, phosphate, calcium, sodium, potassium, magnesium, iron, carbon sources like simple sugars, amino acids, potentially lipids, nucleotides, vitamins and growth factors like insulin; regular commercially available media like alpha-MEM, DMEM, Ham's-F12 and IMDM supplemented with 2-4 mM L-glutamine and 5% Fetal bovine serum; regular commercially available animal protein free media like Hyclone™ SFM4-CHO, Sigma CHO DHFR⁻, Cambrex POWER™ CHO CD supplemented with 2-4 mM L-glutamine. These media are desirably prepared without thymidine, hypoxanthine and L-glycine to maintain selective pressure, allowing stable protein-product expression.

Additional details of the production of the polypeptides and nucleic acids of the invention are given in the Examples.

Therapeutic Applications

The polypeptides and nucleic acid molecules described herein can have a wide variety of therapeutic applications, e.g., in the fields of disorders associated with overactivation of FGFR3 (e.g., bone and cartilage disorders, e.g., achondroplasia, or cancers, e.g., multiple myeloma) or vascular smooth muscle disorders or bone or cartilage disorders, e.g., that are not associated with overactivation of FGFR3. In addition, the polypeptides and nucleic acid molecules described herein can be used for any condition or disorder that would benefit from elongation of bone.

Disorders Associated with Overactivation of FGFR3

Any disorder, disease, or other abnormality that is caused by, or is associated with, overactivation of FGFR3, e.g., stemming from a gain-of-function FGFR3 mutation, may be treated using the compositions and methods described herein. These disorders, diseases, and other abnormalities include, without limitation, bone or cartilage disorders and cancers, each of which is described in more detail below.

Bone or Cartilage Disorders Associated with Overactivation of FGFR3

Any disorder, disease, or other abnormality, e.g., skeletal dysplasia, that affects the function, structure, or growth of bone or cartilage, may be treated using the compositions and methods described herein. In particular, the disorder may be a skeletal dysplasia that is associated with overactivation of FGFR3, such as achondroplasia, including severe achondroplasia with developmental delay and acanthosis; Muenke syndrome (Muenke coronal craniosynostosis); Crouzonodermoskeletal syndrome; hypochondroplasia; thanatophoric dysplasia type I; and thanatophoric dysplasia type II. The compositions and methods of the invention can also be used to treat bone or cartilage disorders not associated with overactivation of FGFR3, and these disorders are described in more detail below.

Cancers

Any cancer that is caused by, or is associated with, overactivation of FGFR3, may be treated using the compositions and methods described herein. These cancers include, e.g., multiple myeloma, myeloproliferative syndromes, leukemia (e.g., plasma cell leukemia), lymphomas, glioblastoma, prostate cancer, bladder cancer, and mammary cancer.

Bone or Cartilage Disorders

The polypeptides and nucleic acid molecules described herein can be used to treat any disorder, disease, or other abnormality that affects the function, structure, or growth of bone or cartilage. These bone or cartilage disorders may be, but do not necessarily have to be, associated with overactivation of FGFR3.

Skeletal dysplasias are bone or cartilage disorders characterized by short stature or dwarfism. Skeletal dysplasias are typically congenital and may include numerous abnormalities in addition to short stature, e.g., short limbs and trunk; bowlegs; a waddling gait; skull malformations, e.g., a large head, cloverleaf skull, craniosynostosis (premature fusion of the bones in the skull), or wormian bones (abnormal thread-like connections between the bones in the skull); anomalies of the hands and feet, e.g., polydactyly (extra fingers), “hitchhiker” thumbs, and abnormal fingernails and toenails; or chest anomalies, e.g., pear-shaped chest or narrow thorax. Non-skeletal abnormalities may also be present in individuals having skeletal dysplasia, e.g., anomalies of the eyes, mouth, and ears, such as congenital cataracts, myopia, cleft palate, or deafness; brain malformations, such as hydrocephaly, porencephaly, hydranencephaly, or agenesis of the corpus callosum; heart defects, such as atrial septal defect, patent ductus arteriosus, or transposition of the great vessels; developmental delays; or mental retardation. Skeletal dysplasias associated with overactivation of FGFR3 include achondroplasia.

Skeletal dysplasias include achondroplasia (e.g., homozygous or heterozygous achondroplasia), achondrogenesis, acrodysostosis, acromesomelic dysplasia, atelosteogenesis, camptomelic dysplasia, chondrodysplasia punctata (e.g., rhizomelic type of chondrodysplasia punctata), cleidocranial dysostosis, congenital short femur, dactyly (e.g., brachydactyl), camptodactyl), polydactyl), or syndactyly, diastrophic dysplasia, dwarfism, dyssegmental dysplasia, enchondromatosis, fibrochondrogenesis, fibrous dysplasia, hereditary multiple exostoses, hypochondroplasia, hypophosphatasia, hypophosphatemic rickets, Jaffe-Lichtenstein syndrome, Kniest dysplasia, Kniest syndrome, Langer-type mesomelic dysplasia, Marfan syndrome, McCune-Albright syndrome, micromelia, metaphyseal dysplasia (e.g., Jansen-type metaphyseal dysplasia), metatrophic dysplasia, Morquio syndrome, Nievergelt-type mesomelic dysplasia, neurofibromatosis (e.g., type 1, e.g., with bone manifestations or without bone manifestations; type 2; or schwannomatosis), osteoarthritis, osteochondrodysplasia, osteogenesis imperfecta (e.g., perinatal lethal type of osteogenesis imperfecta), osteopetrosis, osteopoikilosis, peripheral dysostosis, Reinhardt syndrome, Roberts syndrome, Robinow syndrome, short-rib polydactyly syndromes, short stature, spondyloepiphyseal dysplasia congenita, spondyloepimetaphyseal dysplasia, or thanatophoric dysplasia.

In particular, some forms of craniosynostosis are the result of mutations in one of the fibroblast growth factor receptors (e.g., one or more of FGFR1, FGFR2, or FGFR3) that cause the activation of the MAPK pathway. This is the case for Muenke (Muenke coronal craniosynostosis), Crouzon, Apert, Jackson-Weiss, Pfeiffer, and Crouzonodermoskeletal syndromes, for example. There is genetic and biochemical evidence in the scientific literature that agents that can prevent activation of the MAP-kinase (ERK 1/2) can prevent craniosynostosis in animal models. In particular, use of a MEK1/2 inhibitor (e.g., U0126), which prevents activation of ERK 1/2 can prevent craniosynostosis in an animal model of Apert syndrome (Shukla et al., Nat. Genet. 39:1145, 2007). Accordingly, the compounds of the present invention, which can prevent activation of the MAP-kinase pathway, could be used to treat these forms of craniosynostosis.

Achondroplasia

Achondroplasia is an autosomal dominant skeletal dysplasia that is the most common cause of dwarfism in humans. Its incidence is approximately 1 in 20,000 live births. Skeletal manifestations include growth retardation (with an average adult height of 123-131 cm (4 feet ½ in.-4 feet 3½ in.)), skull deformities, and orthodontic defects. Extraskeletal manifestations include cervical cord compression (with risk of death, e.g., from central apnea or seizures); spinal stenosis (e.g., leg and lower back pain); hydrocephalus (e.g., requiring cerebral shunt surgery); hearing loss due to chronic otitis; cardiovascular disease; neurological disease; higher frequency of accidents; and obesity.

Babies are often diagnosed at birth. While the homozygous form is usually lethal, individuals diagnosed with the heterozygous form have a life expectancy, on average, of 15 years less than the normal population.

Heterozygous or homozygous achondroplasia, or any of its manifestations or phenotypes, can be treated using the compositions and methods described herein. Treatment of either form may be started as early as possible in the patient's life, e.g., shortly after birth, or even in utero; this is particularly important for treatment of the homozygous form, which is typically much more severe and is often lethal if untreated.

Vascular Smooth Muscle Disorders

The polypeptides and nucleic acid molecules described herein can be used to treat any disorder, disease, or other abnormality that affects the function, structure, or growth of vascular smooth muscle. Exemplary vascular smooth muscle disorders are hypertension, restenosis, arteriosclerosis, acute decompensated heart failure, congestive heart failure, cardiac edema, nephredema, hepatic edema, acute renal insufficiency, and chronic renal insufficiency.

Conditions for Elongation of Bone

Any condition, disorder, disease, or other abnormality that would benefit from elongation of bone may be treated using the compositions and methods described herein. These conditions, disorders, diseases, and other abnormalities include, without limitation, insufficient or impaired bone growth arising from fractures, renal failure or insufficiency, poor diet, vitamin deficiency, or hormone deficiency. Healthy subjects, e.g., those without any conditions, disorders, diseases, or other abnormalities related to bone or cartilage, may also be treated using the compositions and methods described herein, e.g., for cosmetic purposes.

Skeletal dysplasias are also associated with shortened segments of long bones. Exemplary skeletal dysplasias include those associated with rhizomelia (or shortening in a proximal segment of a limb, e.g., in the humerus or femur), such as achondroplasia, atelosteogenesis, congenital short femur, diastrophic dysplasia, hypochondroplasia, Jansen type of metaphyseal dysplasia, rhizomelic type of chondrodysplasia punctata, spondyloepiphyseal dysplasia congenita, and thanatophoric dysplasia; mesomelia (or shortening in a middle segment of a limb, e.g., in the radius, ulna, tibia, or fibula), such as Langer and Nievergelt types of mesomelic dysplasias, Robinow syndrome, and Reinhardt syndrome; acromelia (or shortening in a distal segment of a limb, e.g., in the metacarpals or phalanges), such as acrodysostosis and peripheral dysostosis; acromesomelia (or shortening in the middle and distal segments of limbs, e.g., in the forearms and hands), such as acromesomelic dysplasia; micromelia (or shortening in the entire limb), such as achondrogenesis, fibrochondrogenesis, dyssegmental dysplasia, Kniest dysplasia, and Roberts syndrome; or short-trunk, such as Dyggve-Melchior-Clausen disease, Kniest syndrome, metatrophic dysplasia, Morquio syndrome, spondyloepimetaphyseal dysplasia, and spondyloepiphyseal dysplasia congenita.

Formulation

Formulation will depend on the route of administration, as well as on other therapeutic goals. The polypeptides and nucleic acid molecules described herein can be administered by any route known in the art, e.g., subcutaneous (e.g., by subcutaneous injection), intravenously, orally, nasally, intramuscularly, sublingually, intrathecally, or intradermally. By way of example, pharmaceutical compositions of the invention can be in the form of a liquid, solution, suspension, pill, capsule, tablet, gelcap, powder, gel, ointment, cream, nebulae, mist, atomized vapor, aerosol, or phytosome.

In some embodiments of the invention, the compositions of the invention can be administered subcutaneously. Subcutaneous administration is advantageous because it is relatively non-invasive and offers desirable pharmacokinetic profiles. Suitable volumes are known to those skilled in the art, and are typically 5 mL or smaller (e.g., 4 mL, 3.5 mL, 3 mL, 2.7 mL, 2.5 mL, 2.3 mL, 2.2 mL, 2.1 mL, 2.0 mL, 1.9 mL, 1.8 mL, 1.7 mL, 1.5 mL, 1.3 mL, 1.0 mL, 0.7 mL, 0.5 mL, 0.3 mL, 0.1 mL, 0.05 mL, 0.01 mL, or smaller). Typically, the compositions of the invention can be formulated at a concentration between 1 mg/mL and 500 mg/mL (e.g., between 10 mg/mL and 300 mg/mL, 20 mg/mL and 120 mg/mL, 40 mg/mL and 200 mg/mL, 30 mg/mL and 150 mg/mL, 40 mg/mL and 100 mg/mL, 50 mg/mL and 80 mg/mL, or 60 mg/mL and 70 mg/mL) for subcutaneous administration. For oral administration, tablets or capsules can be prepared by conventional means with pharmaceutically acceptable excipients such as binding agents, fillers, lubricants, disintegrants, or wetting agents. The tablets can be coated by methods known in the art. Liquid preparations for oral administration can take the form of, for example, solutions, syrups, or suspension, or they can be presented as a dry product for constitution with saline or other suitable liquid vehicle before use. Compositions of the invention for oral administration also can contain pharmaceutically acceptable excipients such as suspending agents, emulsifying agents, non-aqueous vehicles, preservatives, buffer salts, flavoring, coloring, and sweetening agents as appropriate. Preparations for oral administration also can be suitably formulated to give controlled release of the active ingredients.

Enteric coatings can further be used on tablets of the present invention to resist prolonged contact with the strongly acidic gastric fluid, but dissolve in the mildly acidic or neutral intestinal environment. Without being so limited, cellulose acetate phthalate, Eudragit™ and hydroxypropyl methylcellulose phthalate (HPMCP) can be used in enteric coatings of pharmaceutical compositions of the present invention. Cellulose acetate phthalate concentrations generally used are 0.5-9.0% of the core weight. The addition of plasticizers improves the water resistance of this coating material, and formulations using such plasticizers are more effective than when cellulose acetate phthalate is used alone. Cellulose acetate phthalate is compatible with many plasticizers, including acetylated monoglyceride; butyl phthalybutyl glycolate; dibutyl tartrate; diethyl phthalate; dimethyl phthalate; ethyl phthalylethyl glycolate; glycerin; propylene glycol; triacetin; triacetin citrate; and tripropionin. It is also used in combination with other coating agents such as ethyl cellulose, in drug controlled-release preparations.

The compounds of the invention may be administered in combination with pharmaceutically acceptable, sterile, aqueous or non-aqueous solvents, suspensions or emulsions. Examples of nonaqueous solvents are propylene glycol, polyethylene glycol, vegetable oil, fish oil, and injectable organic esters. Aqueous carriers include water, water-alcohol solutions, emulsions or suspensions, including saline and buffered medical parenteral vehicles including sodium chloride solution, Ringer's dextrose solution, dextrose plus sodium chloride solution, Ringer's solution containing lactose, or fixed oils. Intravenous vehicles may include fluid and nutrient replenishers, electrolyte replenishers, such as those based upon Ringer's dextrose, and the like.

In some embodiments, the pharmaceutical compositions of the present invention can be delivered in a controlled release system. In some embodiments, polymeric materials including polylactic acid, polyorthoesters, cross-linked amphipathic block copolymers and hydrogels, polyhydroxy butyric acid and polydihydropyrans can be used (see also Smolen and Ball, Controlled Drug Bioavailability, Drug product design and performance, 1984, John Wiley & Sons; Ranade and Hollinger, Drug Delivery Systems, pharmacology and toxicology series, 2003, 2^(nd) edition, CRRC Press). In another embodiment, a pump may be used (Saudek et al., 1989, N. Engl. J. Med. 321: 574).

The compositions of the invention could be formulated in the form of a lyophilized powder using appropriate excipient solutions (e.g., sucrose) as diluents.

Furthermore, cells can be isolated from an individual having a disorder associated with overactivation of FGFR3, e.g., achondroplasia, a bone or cartilage disorder, or a vascular smooth muscle disorder or from an individual that would benefit from bone elongation; transformed with a nucleic acid of the invention; and reintroduced to the afflicted individual (e.g., subcutaneous or intravenous injection). Alternatively, the nucleic acid can be administered directly to the afflicted individual, for example, by injection. The nucleic acid can also be delivered through a vehicle such as a liposome, which can be designed to be targeted to a specific cell type, and engineered to be administered through different routes.

The compositions of the present invention may also be used in combination with at least one other active ingredient to correct, e.g., an achondroplasia phenotype.

Gene Therapy

The polypeptides described herein could also be advantageously delivered through gene therapy, where an exogenous nucleic acid encoding the proteins is delivered to tissues of interest and expressed in vivo. Gene therapy methods are discussed, e.g., in Verme et al. (Nature 389:239-242, 1997), Yamamoto et al. (Molecular Therapy 17:S67-S68, 2009), and Yamamoto et al., J. Bone Miner. Res. 26:135-142, 2011), each of which is hereby incorporated by reference. Both viral and non-viral vector systems can be used. The vectors may be, for example, plasmids, artificial chromosomes (e.g., bacterial, mammalian, or yeast artificial chromosomes), virus or phage vectors provided with an origin of replication, and optionally, a promoter for the expression of the nucleic acid encoding the viral polypeptide and optionally, a regulator of the promoter. The vectors may contain one or more selectable marker genes, for example, an ampicillin or kanamycin resistance gene in the case of a bacterial plasmid or a resistance gene for a fungal vector. Vectors may be used in in vitro, for example, for the production of DNA, RNA, or the viral polypeptide, or may be used to transfect or transform a host cell, for example, a mammalian host cell, e.g., for the production of the viral polypeptide encoded by the vector. The vectors may also be adapted to be used in vivo, for example, in a method of vaccination or gene therapy.

Examples of suitable viral vectors include, retroviral, lentiviral, adenoviral, adeno-associated viral, herpes viral, including herpes simplex viral, alpha-viral, pox viral, such as Canarypox and vaccinia-viral based systems. Gene transfer techniques using these viruses are known in the art. Retrovirus vectors, for example, may be used to stably integrate the nucleic acids of the invention into the host genome. Replication-defective adenovirus vectors by contrast remain episomal and therefore allow transient expression. Vectors capable of driving expression in insect cells (e.g., baculovirus vectors), in human cells, yeast, or in bacteria may be employed in order to produce quantities of the viral polypeptide(s) encoded by the nucleic acids of the invention, for example, for use in subunit vaccines or in immunoassays. Useful gene therapy methods include those described in WO 06/060641, U.S. Pat. No. 7,179,903 and WO 01/36620 (each of which is hereby incorporated by reference), which use an adenovirus vector to target a nucleic acid of interest to hepatocytes as protein producing cells.

In an additional example, a replication-deficient simian adenovirus vector may be used as a live vector. These viruses contain an E1 deletion and can be grown on cell lines that are transformed with an E1 gene. Examples of these replication-deficient simian adenovirus vectors are described in U.S. Pat. No. 6,083,716 and WO 03/046124 (each of which is hereby incorporated by reference). These vectors can be manipulated to insert a nucleic acid of the invention, such that the encoded viral polypeptide(s) may be expressed.

Promoters and other expression regulatory signals may be selected to be compatible with the host cell for which expression is designed. For example, mammalian promoters include the metallothionein promoter, which can be induced in response to heavy metals such as cadmium, and the β-actin promoter. Viral promoters, such as the SV40 large T antigen promoter, human cytomegalovirus (CMV) immediate early (1E) promoter, rous sarcoma virus LTR promoter, adenovirus promoter, or a HPV promoter, particularly the HPV upstream regulatory region (URR) may also be used. All these promoters, as well as additional promoters, are well-described in the art.

The nucleic acid molecules described herein may also be administered using non-viral based systems. For example, these administration systems include microsphere encapsulation, poly(lactide-co-glycolide), nanoparticle, and liposome-based systems. Non-viral based systems also include techniques facilitating the delivery of “naked” polynucleotides (such as electroporation, “gene gun” delivery and various other techniques used for the introduction of polynucleotides).

The introduced polynucleotide can be stably or transiently maintained in the host cell. Stable maintenance typically requires that the introduced polynucleotide either contains an origin of replication compatible with the host cell or integrates into a replicon of the host cell such as an extrachromosomal replicon (e.g., a plasmid) or a nuclear or mitochondrial chromosome.

Dosage

Any amount of a pharmaceutical composition of the invention can be administered to a subject. The dosages will depend on many factors, including the mode of administration and the age of the subject. Typically, the amount of the composition of the invention contained within a single dose will be an amount that is effective to treat a disorder associated with overactivation of FGFR3, a bone or cartilage disorder, or a vascular smooth muscle disorder, or to elongate bone, without inducing significant toxicity. For example, the polypeptides described herein can be administered to subjects in individual doses ranging, e.g., from 0.01 mg/kg to 500 mg/kg (e.g., from 0.05 mg/kg to 500 mg/kg, from 5 mg/kg to 500 mg/kg, from 0.1 mg/kg to 100 mg/kg, from 10 mg/kg to 100 mg/kg, from 0.1 mg/kg to 50 mg/kg, 0.5 mg/kg to 25 mg/kg, 1.0 mg/kg to 10 mg/kg, 1.5 mg/kg to 5 mg/kg, or 2.0 mg/kg to 3.0 mg/kg) or from 1 μg/kg to 1,000 μg/kg (e.g., from 5 μg/kg to 1,000 μg/kg, from 1 μg/kg to 750 μg/kg, from 5 μg/kg to 750 μg/kg, from 10 μg/kg to 750 μg/kg, from 1 μg/kg to 500 μg/kg, from 5 μg/kg to 500 μg/kg, from 10 μg/kg to 500 μg/kg, from 1 μg/kg to 100 μg/kg, from 5 μg/kg to 100 μg/kg, from 10 μg/kg to 100 μg/kg, from 1 μg/kg to 50 μg/kg, from 5 μg/kg to 50 μg/kg, or from 10 μg/kg to 50 μg/kg). Exemplary doses include, e.g., 0.01, 0.05, 0.1, 0.5, 1, 2, 2.5, 5, 10, 20, 25, 50, 100, 125, 150, 200, 250, or 500 mg/kg; or 1, 2, 2.5, 5, 10, 20, 25, 50, 100, 125, 150, 200, 250, 500, 750, 900, or 1,000 μg/kg. For all dosages or ranges recited herein, the term “about” may be used to modify these dosages by ±10% of the recited values or range endpoints.

Doses can be administered, e.g., hourly, bihourly, daily, bidaily, twice a week, three times a week, four times a week, five times a week, six times a week, weekly, biweekly, monthly, bimonthly, or yearly. Alternatively, doses can be administered, e.g., twice, three times, four times, five times, six times, seven times, eight times, nine times, 10 times, 11 times, or 12 times per day. In particular preferred embodiments, the dosing regimen is once weekly. The duration of the dosing regimen can be, e.g., 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, or 30 day(s), week(s), or month(s), or even for the remaining lifespan of the subject. The amount, frequency, and duration of dosage will be adapted by the clinician in accordance with conventional factors such as the extent of the disease and different parameters from the subject.

The nucleic acids of the invention can be administered according the formulations described herein to a patient in dosages suitable for gene therapy. The amount of the nucleic acids administered will depend on a number of factors known to those skilled in the art, including: the length and nature of the nucleic acid, the vector (e.g., viral or non-viral) used, the activity of the polypeptide encoded, the presence of excipients, the route and method of administration, and the general condition and fitness of the subject. Exemplary dosages and routes of administration are described, e.g., in Melman et al. (Isr. Med. Assoc. J. 9:143-146, 2007; describing the intrapenile injection of 0.5 mg to 7.5 mg of a human cDNA in a plasmid for treating erectile dysfunction), Powell et al. (Circulation 118:58-65, 2008; describing the intramuscular injection of 0.4 mg to 4.0 mg of a hepatocyte growth factor plasmid to treat critical limb ischemia, Waddill et al. (AJR Am. J. Roentgenol. 169:63-67, 1997; describing the CT-guided intratumoral injection of 0.01 mg to 0.25 mg of plasmid DNA encoding an MHC antigen to treat melanoma), Kastrup et al. (J. Am. Coll. Cardiol. 45:982-988, 2005; describing the intramyocardial injection of 0.5 mg of a VEGF plasmid to treat severe angina pectoris), and Romero et al. (Hum. Gene. Ther. 15:1065-1076, 2004; describing the intramuscular injection of 0.2 mg to 0.6 mg of a plasmid to treat Duchenne/Becker muscular dystrophy), each of which is hereby incorporated by reference.

In certain embodiments, the nucleic acids of the invention can be administered to the subject at a dose in the range from, e.g., 0.01 mg to 100 mg (e.g., from 0.05 mg to 50 mg, 0.1 mg to 10 mg, 0.3 mg to 3 mg, or about 1 mg) of nucleic acid. The total volume at which the nucleic acid can be administered will depend on its concentration, and can range from, e.g., 1 μL to 10 mL (e.g. from 10 μL to 1 mL, 50 μL to 500 μL, 70 μL to 200 μL, 90 μL to 150 μL or 100 μL to 120 μL).

The nucleic acids can be administered, e.g., hourly, bihourly, daily, bidaily, twice a week, three times a week, four times a week, five times a week, six times a week, weekly, biweekly, monthly, bimonthly, or yearly. Alternatively, the nucleic acids can be administered, e.g., twice, three times, four times, five times, six times, seven times, eight times, nine times, 10 times, 11 times, or 12 times per day. The duration of the dosing regimen can be, e.g., 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, or 30 day, weeks, or months, or even for the remaining lifespan of the subject.

These are guidelines, since the actual dose should be carefully selected and titrated by an attending physician or nutritionist based upon clinical factors unique to each subject. The optimal periodic dose will be determined by methods known in the art and will be influenced by factors such as the age of the subject, as indicated above, and other clinically relevant factors. In addition, subjects may be taking medications for other diseases or conditions. The other medications may be continued during the time that a polypeptide or nucleic acid of the invention is given to the subject, but it is advisable in such cases to begin with low doses to determine if adverse side effects are experienced.

EXAMPLES

The examples provided below are intended to illustrate the invention, not limit it.

Example 1 Cloning, Production, and Purification of NC2 Streptag

An Fc-CNP fusion protein was designed as shown in FIGS. 8A and 8B. This protein, termed “NC2 Streptag” or “NC2st,” has a 25-amino acid N-terminal signal sequence that is cleaved during expression. The mature protein has the following domain structure, from N terminus to C terminus: Strep-tag II sequence (to facilitate purification) flanked by short linker sequences; TEV protease cleavage sequence, followed by a short linker; Fc domain of human IgG-1; 16-amino acid glycine-rich linker; and CNP22.

The coding sequence for NC2st was chemically synthesized (FIG. 8C, SEQ ID NO: 801) and inserted in a small cloning plasmid using standard techniques known in the art. The coding sequence of NC2st was then inserted in a mammalian expression vector and transiently transfected in a proprietary HEK293 cell line (Biotechnology research institute, NRCC, Animal Cell Technology Group, Montreal). NC2st was secreted in the culture medium for seven days prior to harvesting of culture supernatant.

Culture supernatant containing NC2st protein was concentrated 10-fold by tangential flow filtration, filtered on 0.45 μm membrane in sterile conditions and kept at 4° C. Concentrated harvest was sterile filtered on 0.22 μm membrane prior to loading onto a 180 mL Streptactin column (IBA GmbH). Purification was performed on an AKTA FPLC system, utilizing Unicorn control software. Streptactin column was first equilibrated with 5 CV of 100 mM Tris-Cl, 150 mM NaCl, 1 mM EDTA, pH 8.0, then concentrated harvest was loaded using a 5 minutes contact time, and column was washed with 6 CV of 100 mM Tris-Cl, 150 mM NaCl, 1 mM EDTA, pH 8.0. NC2st protein was eluted in steps by pausing two minutes between each elution fraction with 10×0.5 CV of 100 mM Tris-C1, 150 mM NaCl, 1 mM EDTA, 2.5 mM desthiobiotin, pH 8.0. Eluate was then dialyzed, concentrated and formulated in 25 mM sodium phosphate, 150 mM NaCl, pH 7.4.

Alternatively, CNP-Fc or Fc-CNP proteins were purified on protein A sorbent (MabSelect SuRe, GE Healthcare). A 180 mL column was first equilibrated with 5 column volumes (CV) of EQ buffer (50 mM NaPO₄, 100 mM NaCl, pH 7.5). After loading the column with ˜1 L of harvest media containing ˜2.4 g/L of Fc-CNP, the column was washed with 3 CV of EQ buffer, 4 CV of Wash2 buffer (100 mM sodium citrate, 1.5 M NaCl, pH 6.0), and 3 CV of Wash3 buffer (100 mM sodium citrate pH 6.0). The protein was then eluted using 3 CV of elution buffer (100 mM sodium citrate, 0.1M L-Arginine, pH 3.5) into an appropriate container containing 67% of the elution volume of neutralization buffer (1.5 M Tris-Cl pH 7.6). The purified protein was finally concentrated and dialysed against phosphate buffer (25 mM NaPO₄, 150 mM NaCl, pH 7.4) using 10 kDa cutoff Vivaspin units (Sartorius VS2022) or a TFF 10 kDa Kvick Lab SCU unit (GE healthcare). The overall yield of the purification procedure was ˜80%, with purity surpassing 95% as assessed by SYPRO® Ruby stained 4-12% SDS-PAGE (Invitrogen Inc.) and size exclusion HPLC. The purified protein preparations were stored at 4-6° C. and remained stable for several months.

Example 2 Whole Cell Guanylyl Cyclase Assay

HEK293S cells in a semi-confluent 75 cm2 flask are transfected with 30 μg of plasmid DNA coding for the appropriate receptor, e.g., human NPR-B or NPR-A, using Lipofectamine-2000CD. Alternatively, a stable polyclonal HEK293 S cell line expressing either human NPR-B or NPR-A was used. 24 hours after transfection, cells are trypsinized and plated into 48-well plates at 1×10⁵ cells/well. Guanylyl cyclase assay is carried out 24 hours post-plating. Cells are first incubated for 30 minutes at 37° C. with serum-free DMEM medium. Then, they are incubated in triplicate with or without increasing concentrations of reference or test proteins in serum-free DMEM supplemented with 1 mM IBMX and 0.5% BSA, at 37° C. for 30 minutes to one hour. CNP serves as a suitable reference for NPR-B, while ANP is a suitable reference for NPR-A. Finally, cells are washed with ice-cold PBS and solubilized in lysis buffer from Catchpoint cGMP kit (Molecular devices). Concentrations of cGMP in lysate are determined using the Catchpoint cGMP kit. Dose-response curves are analysed with GraphPad Prism 5 software using non-linear regression with four-parameter logistic equation.

Example 3 Membrane Guanylyl Cyclase Assay

HEK293 cells expressing either NPR-B or NPR-A are used to prepare crude membrane preparations: Cells are resuspended in TH buffer (50 mM Hepes, 50 mM NaCl, pH 7.4, 10% glycerol, Protease inhibitor tablet (Roche cat. number 11697498001, one tablet for 35 mL of buffer), 50 mM sodium fluoride, 10 mM sodium pyrophosphate, 25 mM glycerol 2-phosphate) and homogenized using a polytron homogenizer. After centrifugation for 30 minutes at 38,000 g, cells are homogenized again and this washing procedure is repeated two more times. The crude membrane pellet is then homogenized in FB buffer (50 mM Hepes, 50 mM NaCl, 250 mM sucrose, 1 mM MgCl₂, pH 7.4, 10% glycerol, Protease inhibitor cocktail (Roche cat. number 11873580001, one tablet for 25 mL of buffer), 50 mM sodium fluoride, 25 mM glycerol 2-phosphate), aliquoted at 200 μL into 1.5 mL eppendorf tubes and quickly frozen in liquid nitrogen before storing at −80° C. Membranes are then used to generate cGMP dose-response curves by adding increasing concentrations of agonist peptides or proteins to 10 μg of crude preparation in 100 μL of buffer A (25 mM HEPES, 50 mM NaCl pH 7.5) containing 1 mM GTP, 1 mM ATP, 10 mM theophyllin, 2 mM IBMX, 100 U/mL of creatine kinase, 10 mM creatine phosphate, 5 mM MgCl₂, into a 1.2 mL deep-well plate. Plate is incubated for 15-20 minutes in a 37° C. water bath before adding 500 μL of ice-cold 110 mM zinc acetate to each well and placing the plates on ice. After addition of 500 μL of 110 mM sodium carbonate to each well, plates are agitated on a plate shaker at 600 rpm for two minutes. Content of each well is transferred to a 1.5 mL eppendorf tube and centrifuged five minutes at 20,000 g. Supernatant is transferred to a new 1.5 mL eppendorf tube. cGMP concentrations are determined using the Catchpoint cGMP kit. Dose-response curves are analysed with GraphPad Prism 5 software using non-linear regression with four-parameter logistic equation.

It should be noted that, in general, membrane assays for NPR-B result in significantly higher (less potent) EC₅₀ values than corresponding whole cell assays; thus, absolute EC₅₀ measurements in whole cell assays should generally not be compared to absolute EC₅₀ determinations in membrane assays. When comparing results across assay types, it is more instructive to compare relative EC₅₀ ratios between a test compound and a control compound than to compare absolute EC₅₀ values.

Example 4 In Vivo Pharmacokinetic Study of NC2st Administered IV or SC in C57BL/6 Mice

Objective

The objectives of this study were the determination of the non-compartmental pharmacokinetic parameters of NC2st following intravenous and subcutaneous administration to mice and the calculation of its subcutaneous bioavailability.

Experimental Design

NC2st was formulated at a concentration of 5.79 mg/mL in 25 mM sodium phosphate pH 7.4, 150 mM NaCl. The animals received NC2st as a single IV or SC dose (20 mg/kg) as described in Table 3 below.

TABLE 3 Group Group Dose Level Animals No. No. description (mg/kg) Bleeding schedule Males 1 NC2 20 0.5, 21 and 26 hr post dose 101, 102, 103 Streptag 1, 8 and 49 hr post dose 104, 105, 106 IV 3, 12 and 32 hr post dose 107, 108, 109 2 NC2 20 6, 21 and 26 hr post dose 201, 202, 203 Streptag 1, 8 and 49 hr post dose 204, 205, 206 SC 3, 12 and 32 hr post dose 207, 208, 209

Injections were scheduled between 7:00 and 10:15 AM. Each mouse was injected with test article subcutaneously into the scapular region or immobilized in a rodent restrainer and injected with the test article as an intravenous bolus via the caudal vein. The dose volume was set at 3.45 mL/kg. The animals received only one dose before scheduled blood collection and sacrifice. Individual body weights were assessed before scheduled test article injection and the volume of test article administered was based on body weight determination.

Blood Collection

Blood samples (0.1 to 0.12 mL) were collected via a jugular vein under isoflurane anesthesia at different time points. At the last time point, blood samples were collected by cardiac puncture under isoflurane anesthesia.

Blood samples were collected into Microvette 200Z/gel tube (Sarstedt, serum/gel clotting activator, #20.1291), incubated at room temperature for 30 to 60 minutes, and centrifuged at 10,000×g for five minutes at 2-8° C. Serum was then transferred into a fresh 0.5 mL tube (Sarstedt, #72.699), snap-frozen in liquid nitrogen, and stored at −80° C. until analysis.

Test Article Concentration in Serum

The presence of NC2st in serum samples was assessed using a CNP22 fluorescent EIA kit (Phoenix Pharmaceuticals, cat# FEK-012-03). Formulated NC2st protein spiked in serum served as a standard. Pharmacokinetic profiles were derived from the concentration measured by EIA.

Terminal Procedure

Animals were sacrificed by bilateral thoracotomy under isoflurane anesthesia following collection of their last sample.

Non-Compartmental Pharmacokinetic Analysis

A non-compartmental analysis (NCA) was used to calculate the pharmacokinetic parameters of testing compound. All measured serum concentrations of testing compound versus time profile were processed using WinNonlin™ Enterprise Edition version 5.2.12. NCA Model 200 was selected for extravascular input or Model 201 for IV-Bolus input using sparse sampling analysis module for both models.

The following non-compartmental PK parameters were calculated:

-   -   Area under the curve from time zero to the last detectable         concentration (AUC_(last)), calculated using the linear         trapezoidal (linear interpolation);     -   Area under the curve from time zero to infinity (AUC_(∞))         calculated as AUC_(last)+C_(last)/λ_(z) (where λ_(z)=slope of         the terminal phase of the serum concentration vs time curve);     -   Maximum observed serum concentration (C_(max)), time of maximum         serum concentration (T_(max));     -   Terminal elimination half-life (T_(1/2), calculated as         0.693/λ_(z));     -   Systemic clearance (CL) was calculated as Dose/AUC_(∞) and     -   Total volume of distribution (V_(ss)) was calculated using         CL×MRT, where MRT is the mean residence time.

Absolute bioavailability (F %) between routes was calculated using the following formula: [AUC_(∞) (sc)/Dose(sc)]/[AUC_(∞) (iv)/Dose(iv)]×100.

Nominal times were used in the calculations and times are set relative to start of dosing. Nominal doses were used for the calculation of CL.

Results

Mean (±SC) serum concentrations of NC2st in male mice following IV and SC administration are shown in FIG. 9.

Non-compartmental pharmacokinetic parameters of NC2st in male mouse serum are summarized in Table 4.

TABLE 4 PK Parameters Units IV SC AUC_(last) hr · nmol/L 27,587 17,735 AUC_(∞) hr · nmol/L 28,563 19,592 C_(max) nmol/L 2,099 798 T_(max) hr 1.00 6.00 Half-life hr 10.6 14.3 CL L/hr/kg 0.0112 CL_F L/hr/kg 0.0163 Vss L/kg 0.173 Vss_F L/kg 0.353 Bioavailability % 68.5

-   -   Following IV administration of 20 mg/kg (320 nmol/L) of NC2st in         male mice, the exposure PK parameter AUC_(∞) was 28,563 nmol·h/L         and C_(max) was 2,099 nmol/L;     -   Following SC administration of 20 mg/kg (320 nmol/L) of NC2st in         male mice, the exposure PK parameter AUC_(∞) was 19,592 nmol·h/L         and C_(max) was 798 nmol/L;     -   The estimated bioavailable fraction (% F) was 68.5% following SC         administration in male mice; and     -   The estimated SC half-life was 14.3 hours, an approximately         340-fold increase over intravenous CNP22.

In summary, it was determined that NC2st has very favorable pharmacokinetic properties, including a greatly increased half-life, high AUC values, and high bioavailability via the SC route of administration.

Example 5 Evaluation of the Efficacy of Subcutaneous Administration of NC2st on Rescue of the ACH Bone Phenotype in Fgfr3^(369/+) Mice

Objective

The study was designed to evaluate the effect of daily subcutaneous (SC) administration of NC2 Streptag (NC2st) on rescue of the achondroplasia skeletal disorders in the mouse model of the disease, the Fgfr3^(369/+) mice.

Test and Control Articles

Test article: NC2st formulated in 25 mM sodium phosphate, 150 mM NaCl, pH 7.4.

Control article: Vehicle, 25 mM sodium phosphate, 150 mM NaCl, pH 7.4.

Test System

Fgfr3^(369/+) mice were created by an amino acid substitution (Gly to Cys) at position 369 in the mouse Fibroblast Growth Factor Receptor 3 (Fgfr3) gene (Chen et al., J. Clin. Invest. 104(11): 1517-1525, 1999). Substitution 369 (Gly369Cys) in mouse Fgfr3 gene causes dwarfism with features mimicking human achondroplasia. The Fgfr3^(369/+) mice exhibit macrocephaly and shortened limbs due to retarded endochondral bone growth and premature closure of cranial base synchondroses. Mutant mice showed disorganized growth plates, delayed formation of the secondary ossification center and reduced bone density. Thus, the Fgfr3³⁶⁹⁺ mouse is an appropriate model for non-clinical studies evaluating the treatment of achondroplasia.

Rationale for Dose Level and Interval Selection

Based on the relative biological activities of CNP22 and NC2st, as determined in a set of NPR-B whole cell dose-response assays (FIG. 10), it was projected that the targeted NC2st concentrations to achieve 50 and >100% reversal of ACH phenotype would be 345 (±95 S.D.) and 1214 (±446 S.D.) nM, respectively. Based on WinNonlin simulation of NC2st pharmacokinetic data obtained from a single dose pharmacokinetic study in adult mice (FIG. 11), a dose of 10 mg/kg given SC twice daily would achieve >50% reversal. 100 mg/kg twice daily would be sufficient to achieve more than 100% reversal.

Experimental Design

The study was an open label parallel and randomized control study. Treatments were open label, and Table 5 provides details of the treatment groups.

TABLE 5 Fgfr3^(369/+) WT Dose (male & (male & Group Group Duration Dosing Level Conc. female) female) No. description ROA of treatment* Interval (mg/kg) (mg/mL) N = N = 1 V SC 61 Twice 0 0 15 0 injection daily 2 Tx-10 SC 61 Twice 10 2.5 15 0 injection daily 3 Tx-100 SC 61 Twice 100 25 15 0 injection daily 4 WT — — — — — 0 15 WT (wild-type): normal littermate of Fgfr3^(369/+) mice —: not injected ROA: route of administration *The duration of treatment was 61 days, as animals were treated from 3 to 63 days of age. The study duration was 64 days, including necropsy on day 64.

Injections were scheduled twice daily at approximately 8:00 to 10:00 AM and 8:00 to 10:00 PM. The dose volume was set at 4 ml/kg. The actual volume administered to each mouse was calculated and adjusted based on the daily body weight of each animal measured prior to the AM injection. Vehicle or NC2st was injected SC twice daily into the scapular or lumbar region of Fgfr3^(369/+) animals from the third day after birth to 63 days of age.

A summary of the study endpoints is shown in Table 6.

TABLE 6 Occasions Day 3, 10, 17, Day 3 → 24, 31, 38, 45, Necropsy Endpoints Day 63 52, 59 Day 64 Body weight √ √ Crown/Rump length √  √ Tail length √^(a) √ Bone length: tibia and √ femur Test article √ concentration in serum Test article biological √ activity in serum Whole body X-Ray Naso-Anal length √ Neck-Anal length √ Cervical-Thoracic- √ Lumbar length Sternum length √ Skull morphology √ ^(a)on Day 31, 38, 45, 52 and 59

Experimental Procedures

Mortality checks were performed each day and noted in study books. The animals were examined each day. If present, clinical signs were noted in study books.

At necropsy (Day 64), blood samples were collected by cardiac puncture under isoflurane anesthesia 13-18 hours after the last dose. Blood samples were collected into Microvette 500Z/gel tube (Sarstedt, serum/gel clotting activator, #20.1344), incubated at room temperature for 30 to 60 minutes and centrifuged at 10,000×g for five minutes at 2-8° C. 100 μl of serum was then transferred into 0.5 mL tubes (Sarstedt, #72.699), and the remainder was transferred in a second tube. The two tubes were frozen in liquid nitrogen and stored at −80° C. until analysis.

The animals were euthanized by a bilateral thoracotomy under isoflurane anesthesia and a gross pathology check was performed. All gross pathology check findings were reported in study books.

The concentration and biological activity of NC2st in serum samples was assessed using a CNP22 fluorescent EIA kit (Phoenix Pharmaceuticals, cat# FEK-012-03) and a cyclic-GMP fluorescent assay kit (Molecular Devices, cat# R8075), respectively.

Ex vivo radiographs of whole body, rib cage and skull were taken using a Faxitron model MX-20 DC4 under constant conditions (26 kV, 10 sec at 1×, 3× and 3× magnification, respectively). Bone measurements were performed on the radiographic images of all animals in a blinded fashion using the software Image Processing and Analysis in Java (ImageJ).

Bone samples were cleaned of excess tissue (not scraped) and fixed. Length of femur and tibia was measured using a caliper.

Results

Experimental results are shown in FIGS. 12A-12H and are summarized in Table 7 below.

TABLE 7 Tx-10 Tx-100 Length measurement % change vs Vehicle % change vs Vehicle Tibia +6.50%* +8.13%* Femur +3.85%* +3.85%* Naso-anal +8.99%* +14.3%* Neck-anal +12.4%* +21.1%* Total CTL^(a) vertebrae +11.6%* +20.9%* Cervical vertebrae +17.6%* +24.3%* Thoracic vertebrae +11.6%* +25.3%* Lumbar vertebrae +8.64%* +13.6%* Sternum +6.67%* +13.7%* Tail +7.38%* +7.22%* Occipital-front distance +0.89%  +0.76%  Skull Circularity index −1.52%  −2.88%* ^(a)Cervical, thoracic, lumbar *Significant, P < 0.05

In addition, FIG. 13 shows the results of cGMP assays using serum spiked with NC2st (left) and serum from vehicle (Ve), wild-type (WT), Tx-10 dosed (Tx10) mice, and Tx-100 dosed (Tx100) mice (right), in order to be able to determine active concentrations of NC2st present in blood samples using a cGMP assay as described above. The charts and table in FIG. 14 show the active concentrations of NC2st present in blood samples of mice in the Tx10 group (left) and Tx100 group (right), demonstrating that the mean NC2st blood serum level in the Tx10 group was above the projected threshold for 50% reversal of the ACH phenotype, while the mean NC2st blood serum level in the Tx100 group was nearly three-fold above the projected threshold for 100% reversal of the achondroplasia phenotype.

Taken together, these results demonstrate that an Fc-NP fusion, such as NC2st, is capable of reversing the achondroplasia phenotype in a severe mouse model of the disease.

Example 6 Modification of NC2st

NC2st may be varied in several respects, including elimination of the sequence that is N-terminal to the Fc domain (resulting, e.g., in NC2B, as shown in FIGS. 15A-15B), addition of a bone-targeting moiety (resulting, e.g., in D10-NC2, as shown in FIG. 15A), and alteration of the length of the linker between Fc and CNP22 (e.g., NC2B-22 (also referred to as NC₂₋₂₂), NC2B-28 (also referred to as NC₂₋₂₈), and NC2B-34 (also referred to as NC₂₋₃₄), as shown in FIGS. 16A-16D). In one set of experiments, NC2st, NC2B-22, NC2B-28, and NC2B-34 were tested in an NPR-B dose-response whole cell assay. The results of this experiment are shown in FIG. 17. Other exemplary NC2st variants are shown in FIG. 18 (NC2-KGANKK and NC2-KGANQK) and FIG. 19 (NC2-CNP53mut2).

Example 7 Fc-CNP53 Constructs

In this set of experiments, two constructs were prepared in which an N-terminal Fc domain is fused to a variant of CNP53 with a short Gly₃ linker region. An alternative way to analyze these fusion polypeptides is that the linker region is Gly₃ followed by amino acids 1-31 of CNP53 (or variants thereof); viewed in this way, the linker region connects the Fc domain to CNP22 and is 34 amino acids in length.

For Fc-CNP53-A (also referred to as “Fc-CNP53 wt”) (SEQ ID NOs: 517 (with signal sequence) and 518 (without signal sequence); FIG. 20), position 48 of CNP53, corresponding to position 17 of CNP22, was mutated to alanine. Fc-CNP53-AAA (also referred to as “Fc-CNP53mut”) (SEQ ID NOs: 519 (with signal sequence) and 520 (without signal sequence); FIG. 20) has the same sequence as Fc-CNP53-A with the exception that residues 30 and 31 of CNP53, the two residues immediately before CNP22, are mutated to alanine in order to reduce the likelihood of proteolytic cleavage. These two constructs were tested, along with NC2st, in two NPR-B membrane assays and one NPR-B whole cell assay.

In the first membrane assay, Fc-CNP53-A demonstrated more than twice the potency as CNP and slightly better efficacy than CNP, while Fc-CNP53-AAA had a potency of 1.5 times less than that of CNP, and about two-thirds of CNP's efficacy (FIG. 21A). In the second membrane assay, Fc-CNP53-A had a potency of 1.3 times less than that of CNP and comparable efficacy, while Fc-CNP53-AAA had a potency of 3.3 times less than that of CNP and comparable efficacy. The potency of NC2st in the second assay was 19 times less than that of CNP, while the efficacy was 61% that of CNP (FIG. 21B).

In the whole cell assay, Fc-CNP53-A had a potency of 5.4 times less than that of CNP and comparable efficacy, while Fc-CNP53-AAA had a potency of 14 times less than that of CNP and 74% efficacy. The potency of NC2st was 83 times less than that of CNP, while the efficacy was 84% that of CNP (FIG. 21C).

Taken together, these results show that modifying the linker region of an Fc-CNP22 fusion to include the first 31 amino acids of CNP53 results in constructs having even greater potency and efficacy than NC2st in in vitro membrane and whole cell assays.

Example 8 CDNP Variants

CDNP (SEQ ID NO: 100; FIG. 22) is a hybrid NP consisting of CNP22 fused to the C-terminal tail of DNP. This NP agonizes NPR-B but has significant cross-reactivity with NPR-A. In order to increase the selectivity of CDNP for NPR-B, mutations were made in several of the tail residues of CDNP.

In the first set of CDNP experiments, several CDNP variants were tested to evaluate their sensitivity to NEP degradation. The variants tested were CDNP-N1 (SEQ ID NO: 101), CDNP-G1 (SEQ ID NO: 102), CDNP-H1 (SEQ ID NO: 103), and CDNP-K1 (SEQ ID NO: 104), as shown in FIG. 22 (numbers refer to the position of the mutation relative to the DNP tail (SEQ ID NO: 117)), with CDNP and CNP22 included as controls. For the NEP degradation assays, 125 μM of peptide was incubated at 37° C. in 500 μL total of buffer (100 mM Tris-Cl, pH 7.5, 100 mM NaCl) containing 1.25 ng/μL of purified neutral endopeptidase (Innovative research). At times 0 minutes, 10 minutes, 30 minutes, 60 minutes, 120 minutes, and 240 minutes, 70 μL was taken from the tubes and heat inactivated at 100° C. for 10 minutes on a dry heat block. Aliquots were then put on ice or stored at −20° C. After centrifugation at 20,000×g for 5 minutes, 65 μL of the supernatant was transferred to HPLC tubes for 2×20 μL injections into reverse phase HPLC for analysis (Agilent XDB-C18).

Each of the tested variants exhibited significantly decreased sensitivity (i.e., increased resistance) to NEP in comparison to CNP22, with CDNP, CDNP-N1, CDNP-G1, and CDNP-H1 all having comparable NEP sensitivity. CDNP-K1 was slightly more sensitive to NEP than the other CDNP variants but was still much less sensitive than CNP22. Results are shown in FIG. 23. This demonstrates that CDNP, which is substantially more resistant to NEP degradation than CNP22 alone, may be altered without substantial loss of NEP resistance.

Example 9 CDNP Variants at Tail Positions 3, 4, and 5

As shown in FIG. 22, residues 3-5 of the C-terminal extension following the 17-amino acid ring show a significant degree of conservation across natriuretic peptide type and species, and thus these residues may play an important role in NPR-A agonist activity. Mutating one or more of these residues could result in decreased NPR-A agonist activity without significantly impairing NPR-B agonist activity, as CNP22 lacks a C-terminal tail altogether.

In this set of experiments, mutations were introduced at positions 3, 4, and/or 5 of the DNP tail in order to identify CDNP variants having improved selectivity for NPR-B. The following CDNP variants were tested: CDNP-A4 (SEQ ID NO: 107); CDNP-A5 (SEQ ID NO: 108); CDNP-S3A4 (SEQ ID NO: 109); CDNP-A4A5 (SEQ ID NO: 110); CDNP-S3A5 (SEQ ID NO: 111); and CDNP-S3A4A5 (SEQ ID NO: 113). Results are shown in FIGS. 24A-24D and in Tables 8-10 below. The experiments are performed under identical conditions. The membrane potency assay is quick and convenient and allows comparison of peptides with CNP or CDNP in the same experiment.

TABLE 8 Whole Cell cGMP Assay Peptide EC₅₀ on NPR-B (nM) EC₅₀ on NPR-A (nM) CNP 4.87 ND ANP ND 1.4 CDNP 25 73

TABLE 9 Membrane cGMP Assay Potency EC₅₀ ratio EC₅₀ ratio Approximate fold versus versus gain in selectivity Approximate CDNP CDNP on versus CDNP fold selectivity on NPR-B NPR-A (column C/column NPR-B Peptide (nM) (nM) B) versus NPR-A CDNP-SAA 1.24-1.03 3.63-30.1 14.9 43.5 CDNP-SRA 1.08 1.33 1.23 3.59 CDNP-LAA 0.49 0.48 0.98 2.86 CDNP-SAD 3.45-2.32  105-59.7 28.5 83.2 CDNP-LRA 0.24 1.33 5.54 16.2 CDNP-LAD 2.31 41.1 17.8 52.0

TABLE 10 Membrane cGMP Assay Efficacy % efficacy versus % efficacy versus % loss in efficacy Peptide CDNP on NPR-B CDNP on NPR-A versus CDNP CDNP-SAA 128-114 34-69 69 CDNP-SRA 118 36 82 CDNP-LAA 85 49 36 CDNP-SAD 91-87 65-59 27 CDNP-LRA 87 114 −27 CDNP-LAD 92 90 2

As the Tables above show, CDNP activated NPR-B with an EC₅₀ value of 25 nM, whereas it activated NPR-A with an EC₅₀ value of 73 nM (3-fold more selective towards NPR-B).

C12 (CDNP-SAD) was ˜83-fold more selective towards NPR-B, 28-fold gain in selectivity compared to CDNP. NPR-B selective efficacy gain was 27%.

C11 (CDNP—SRA) was ˜3.6-fold more selective towards NPR-B, 1.2-fold gain in selectivity compared to CDNP. NPR-B selective efficacy gain was 82%.

C10 (CDNP-SAA) was ˜45-fold more selective towards NPR-B, 15-fold gain in selectivity compared to CDNP. NPR-B selective efficacy gain was 69%.

In addition, CDNP-S3A4, CDNP-S3A5, and CDNP-S3A4A5 were tested to evaluate their sensitivity to NEP degradation, with CDNP and CNP22 included as controls. As shown in FIG. 25, CDNP-S3A4 (CDNPsad) and CDNP-S3A5 (CDNPsra) have comparable NEP sensitivity, while CDNP-S3A4A5 (CDNPsad) is slightly more sensitive to NEP than CDNP. All variants tested were much less sensitive to NEP than CNP22.

In summary, these results demonstrate that the NPR-B/NPR-A selectivity of CDNP can be increased, for example, by mutating the LRD residues at positions 3-5 of the C-terminal tail of CDNP. The S3A4 mutation had the most drastic effect on potency, whereas the S3A5 mutation had the most significant effect on efficacy. In addition, modification of these residues in CDNP did not significantly increase their sensitivity to NEP degradation.

Example 10 NP-Fc Fusions

Fusion polypeptides having an N-terminal NP domain and a C-terminal Fc domain may be constructed. Several examples are shown in FIG. 26A and include CNP-16AAlinker-Fc-His₁₀ (NC1) (SEQ ID NO: 521); CNP-6AAlinker-Fc-His₁₀ (NC3) (SEQ ID NO: 522); CNP-6AAlinker-Fc (SEQ ID NO: 523); CDNP-Fc (SEQ ID NO: 524), which has no linker between the CDNP and Fc moieties; CDNP-A17saa-Fc (SEQ ID NO: 525), which has a mutation to alanine at position 17 of the CNP22 region and mutations S3, A4, and A5 in the DNP tail region; and CDNP-A17sra-Fc (SEQ ID NO: 526), which has a mutation to alanine at position 17 of the CNP22 region and mutations S3 and A5 in the DNP tail region.

In one set of experiments, dose-response NPR-B membrane assays were performed to determine relative potency and efficacy of CDNP-Fc in comparison with CDNP and CNP22. In the first set of experiments, as shown in FIG. 27A, CDNP was 5.5-fold less potent than CNP22, and had 56% of CNP22's efficacy. CDNP-Fc was only 2.6-fold less potent than CNP22 and had 24.5% of CNP22's efficacy. In the second set of experiments, as shown in FIG. 27B, CDNP-Fc was determined to be 22 times less potent and had 51% of the efficacy of CNP22.

CDNP-Fc was further assayed to determine relative potency and efficacy in agonizing NPR-A. As shown in FIG. 27C, CDNP-Fc was 126 times less potent than ANP and had 55% of the efficacy. These experiments demonstrate that CDNP-Fc retains some NPR-A agonizing activity.

Next, CDNP-A17saa-Fc and CDNP-A17sra-Fc were tested in whole cell NPR-B and NPR-A assays, using CNP and ANP, respectively, as controls, to determine relative potency and efficacy in agonizing each of NPR-B and NPR-A. As shown in FIGS. 28A and 28B, CDNP-A17saa-Fc and CDNP-A17sra-Fc agonized NPR-B with 2,721 and 941-fold reduced potency relative to CNP22, respectively, and 68% and 115% efficacy, respectively. However, the potency of these constructs was undetectably small relative to ANP in the NPR-A assay. Thus, these constructs showed much-improved selectivity for NPR-B relative to CDNP-Fc.

Example 11 Point Mutants of CNP22 at Position 17

In this set of experiments, mutations were introduced into CNP22 at position 17 in order to determine whether the wild-type residue at this position, methionine, could be replaced with a residue that is less sensitive to oxidation without substantially reducing potency or efficacy. Residue 17 is one of the less well-conserved positions in CNP22, with naturally-occurring homologs having (without limitation) Phe, Leu, Ile, Thr, Val, or Ser at this position (see, e.g., FIG. 3). Accordingly, the following CNP22 variants were prepared: CNP—F17 (SEQ ID NO: 119); CNP-L17 (SEQ ID NO: 120); CNP-117 (SEQ ID NO: 121); CNP-T17 (SEQ ID NO: 122); CNP-V17 (SEQ ID NO: 123); CNP-A17 (SEQ ID NO: 124); CNP-S17 (SEQ ID NO: 125); CNP-E17 (SEQ ID NO: 156); CNP-R17 (SEQ ID NO: 157); and CNP-Y17 (SEQ ID NO: 158), where the consensus sequence is shown in SEQ ID NO: 126 (where X can be any amino acid, including, without limitation, Phe, Leu, Ile, Thr, Glu, Arg, Tyr, Cys, Pro, Asp, Val, Ala, or Ser) (FIG. 29).

As shown in FIG. 30, various variants were assayed. Variants CNP-R17 and CNP-Y 17 showed improved potency, and CNP-F 17, CNP-L 17, and CNP-T 17 exhibited comparable potency to CNP22. Thus, these results demonstrate that the CNP22 molecule may be modified at position 17 in order to eliminate the oxidation-sensitive methionine residue while maintaining comparable potency.

Example 12 CNP22 Variants and Bone-Targeted NPs

Variants of CNP22 may be designed, e.g., to be resistant to NEP or IDE degradation and retain adequate potency, and/or to include a bone-targeting moiety at the N terminus or C terminus. Exemplary molecules are shown in FIG. 31 (SEQ ID NOs: 127-150). Variants of the molecules shown in FIG. 31 or otherwise described herein may also be utilized, e.g., lacking the bone-targeting moiety, or containing a different bone-targeting moiety. For example, any of E₆, E₇, E₈, E₉, E₁₀, E₁₁, E₁₂, E₁₃, E₁₄, E₁₅, E₁₆, D₆, D₇, D₈, D₉, D₁₀, D₁₁, D₁₂, D₁₃, D₁₄, D₁₅, or D₁₆ may be used as a bone-targeting moiety. A linker, e.g., a flexible linker, may be included between the bone-targeting moiety and the NP. In addition, any of the molecules shown in FIG. 31, with or without the bone-targeting moiety, may be fused to an Fc domain and may optionally further include a linker region between the Fc and NP, as disclosed herein. In addition, the italicized regions in FIG. 31 may be used as N-terminal extensions, C-terminal extensions, and/or linkers for any of the NPs disclosed herein.

Example 13 Additional CNP Variants

Additional variants of CNP may be designed, e.g., to be resistant to NEP or IDE degradation and retain adequate potency, and/or to include a bone-targeting moiety at the N terminus or C terminus. Exemplary molecules are shown in FIGS. 32A-32E (SEQ ID NOs: 1001-1155). Variants of the molecules shown in FIGS. 32A-32E or otherwise described herein may also be utilized, e.g., including a bone-targeting moiety. For example, any of E₆, E₇, E₈, E₉, E₁₀, E₁₁, E₁₂, E₁₃, E₁₄, E₁₅, E₁₆, D₆, D₇, D₈, D₉, D₁₀, D₁₁, D₁₂, D₁₃, D₁₄, D₁₅, or D₁₆ may be used as a bone-targeting moiety. A linker, e.g., a flexible linker, may be included between the bone-targeting moiety and the NP. In addition, any of the molecules shown in FIGS. 32A-32E, with or without the bone-targeting moiety, may be fused to an Fc domain and may optionally further include a linker region between the Fc and NP, as disclosed herein.

Example 14 Evaluation of Daily Bolus Subcutaneous Injection of NC2st on Bone Growth in Wild-Type (CD-1) Mice

Objective

The study was designed to evaluate the relationship between different doses of NC2st and the pharmacologic response on bone. The relationship was evaluated by measuring the effect of increasing doses of NC2st (SEQ ID NO: 502; as described, e.g., in Example 1) on bone growth in wild-type (WT, CD-1) mice. Bone growth response of wild-type and Fgfr3^(369/+) (ACH) mice was compared.

Test Article

Test article: NC2st formulated in 25 mM sodium phosphate, 150 mM NaCl, pH 7.4.

Control article: Vehicle, 25 mM sodium phosphate, 150 mM NaCl, pH 7.4.

Test System

CD-1 mice are a standard rodent species for use in pharmacodynamic studies. Briefly, nursing mothers with fostered female pups of 13 to 16 days were obtained. At the age of 21 days, pups were weaned and randomized based on body weight into treatment groups.

Experimental Design

The animals received NC2st as a subcutaneous injection into the interscapular region as described in Table 11 below.

TABLE 11 Duration Dose WT of Level (CD-1, Group Group treatment Dosing (mg/ female) No. description ROA (days) Interval kg) N = 1 V SC 35 Once 0 16 injection daily 2 Tx-10 SC 35 Once 10 16 injection daily 3 Tx-30 SC 35 Once 30 16 injection daily 4 Tx-100 SC 35 Once 100 16 injection daily ROA: route of administration CD-1 mice were treated at 3 weeks old at the indicated doses for 35 consecutive days, followed by necropsy 24 hours after the last injection. A summary of the study endpoints is shown in Table 12.

TABLE 12 Occasions Day 1 → Day 1, 8, 15, Necropsy Endpoints Day 36 22, 29, 36 Day 36 Body weight √ √ Crown-rump length √ √ (CRL) Tail length √ √ Bone length: right tibia √ √ Bone length: left tibia, √ left femur, left humerus, and left ulna Whole body X-Ray Naso-anal length √ Cervical-Thoracic- √ Lumbar (CTL) length Sternum length √ Metatarsal bone length √ Foramen magnum width √ and height Skull morphology √

Experimental Procedures

Mortality checks were performed each day and noted in study books. The animals were examined each day. If present, clinical signs were noted in study books.

The animals were euthanized by a bilateral thoracotomy under isoflurane anesthesia and a gross pathology check was performed. All gross pathology check findings were reported in study books.

Ex vivo radiographs of whole body, rib cage, and skull were taken using a Faxitron model MX-20 DC4 under constant conditions (26 kV, 10 sec at 1×, 3× and 3× magnification, respectively). Bone measurements were performed on the radiographic images of all animals in a blinded fashion using the software Image Processing and Analysis in Java (ImageJ).

Bone samples were cleaned of excess tissue (not scraped) and fixed. Length of femur and tibia was measured using a caliper.

Results

Experimental results are shown in FIGS. 33A-33Y and are summarized in Table 13 (results at day 36) below.

TABLE 13 Length measurement^(a) V Tx-10 Tx-30 Tx-100 Right Tibia length in vivo (mm) 18.8  19.0  19.4*  20.0* Δ —  0.20  0.60  1.2 % Δ —  1.1  3.2  6.4 Left Tibia length (mm) 18.0  18.5  18.9*  19.3* Δ —  0.5  0.9  1.3 % Δ —  2.8  5.0  7.2 Left Femur length (mm) 15.1  15.6*  16.0*  16.6* Δ —  0.5  0.9  1.5 % Δ —  3.3  6.0  9.9 Left Ulna length (mm) 14.0  14.1  14.5  14.8* Δ —  0.10  0.5  0.8 % Δ —  0.71  3.6  5.7 Left Humerus length (mm) 12.2  12.4  12.5*  12.9* Δ —  0.2  0.3  0.7 % Δ —  1.6  2.5  5.7 Naso-anal length (mm, X-Ray) 108 115* 118* 122* Δ —  7.0  10  14 % Δ —  6.5  9.3  13 Crown-rump length in vivo (mm) 94.9  99.1 102* 107* Δ —  4.2  7.1  12.1 % Δ —  4.4  7.5  12.7 Total CTL^(b) segments (mm, X-Ray) 50.5  55.0*  56.7*  59.5* Δ —  4.5  6.2  9.0 % Δ —  8.9  12.3  17.8 Cervical segment (mm, X-Ray) 8.27  9.00  9.41*  9.95* Δ —  0.73  1.14  1.68 % Δ —  8.8  13.8  20.3 Thoracic segment (mm, X-Ray) 22.9  25.5*  26.2*  27.7* Δ —  2.6  3.3  4.8 % Δ —  11.4  14.4  21.0 Lumbar segment (mm, X-Ray) 19.3  20.5*  21.1*  21.9* Δ —  1.2  1.8  2.6 % Δ —  6.2  9.3  13.5 Tail length in vivo (mm) 96.1 102 106* 112* Δ —  5.9  9.9  15.9 % Δ —  6.1  10.3  16.5 Sternum length (mm, X-Ray) 36.0  38.5*  39.9*  40.5* Δ —  2.5  3.9  34.5 % Δ —  6.9  10.8  12.5 Metatarsal bone (3rd digit) (mm, X-Ray) 23.3  24.5*  24.8*  26.1* Δ —  1.2  1.5  2.8 % Δ —  5.2  6.4  12.0 Foramen magnum height (mm) 4.08  4.13  4.12  4.17 Δ —  0.05  0.04  0.09 % Δ —  1.2  0.98  2.2 Foramen magnum width (mm) 4.66  4.72  4.73  4.72 Δ —  0.06  0.07  0.06 % Δ —  1.3  1.5  1.3 Occipital-front distance 42.3  42.9  42.8  43.2* (mm, X-Ray) Δ —  0.6  0.5  0.9 % Δ —  1.4  1.2  2.1 Circularity index (mm, X-Ray) 0.377  0.370  0.362  0.349* Δ —  −0.007  −0.015  −0.028 % Δ —  −1.9  −4.0  −7.4 ^(a)Δ and % Δ compared to Vehicle ^(b)Cervical, thoracic, and lumbar *Significant compared with Vehicle, P < 0.05

For in vivo measurements, NC2st-treated mice showed significantly longer crown-rump, tail, and tibia lengths in a dose-dependent manner compared to Vehicle. For both crown-rump and tail lengths, significant differences were reached after 2 weeks of treatment with both Tx-30 and Tx-100. Tibia length was significantly different versus Vehicle after 2 weeks (Tx-100) or 4 weeks (Tx-30) of treatment.

After 5 weeks of treatment, dose-dependent elongation of long bones was observed in NC2st-treated mice. In the Tx-100 group, significant bone growth was observed in the femur (10%), tibia (7%), ulna, and humerus (6%). In addition, body lengths (naso-anal) were statistically longer for Tx-10, Tx-30, and Tx-100 treated mice and reached 7%, 9%, and 13% increase, respectively. Spine segments (cervical-thoracic-lumbar) lengths were statistically longer at all doses (except cervical lengths for Tx-10). Metatarsal bone (3rd digit) lengths were statistically increased at all doses in a dose-dependent manner. Skull circularity decreased in a dose-dependent manner, and the occipital-front distance was statistically increased in Tx-100. Sternum lengths were statistically increased at all doses in a dose-dependent manner.

Data are provided for treatment with NC2st in wild-type CD-1 mice (Table 13) and in mice models for achondroplasia (Table 7). These results show that an Fc-NP fusion provides efficacy in both wild-type mice and severe mouse models of disease. Taken together, these results demonstrate that an Fc-NP fusion, such as NC2st, is capable of promoting bone growth and elongation in a dose-dependent manner. Using the methods described herein, the efficacy of NP polypeptides and Fc-NP fusions can be evaluated (e.g., at 10 mg/kg, 30 mg/kg or 100 mg/kg doses) in healthy mice (e.g., to elongate bone) and in mice models for disease.

Example 15 Stability of CNP Variants

Numerous CNP variants were synthesized and tested for their susceptibility to peptidase degradation by neutral endopeptidase (NEP), a known CNP degrading pathway in vivo. The sequences of the tested CNP variants are provided in FIG. 34 and described below.

NEP degradation was determined by the experiments performed under the following conditions. Generally, 100 μM of peptide was incubated at 37° C. in 500 μL total of buffer (100 mM Tris-C1, pH 7.5, 100 mM NaCl) containing 1.25 ng/μL of NEP. At various time points (0 min., 30 min., 60 min., 120 min., and 240 min.), 70 μL was taken from the tubes and heat inactivated at 100° C. for 10 minutes on the dry heat block. After centrifugation at 14,000 rpm for 5 minutes, 70 μL of the supernatant was transferred to HPLC tubes for 2×20 μL injections into RP-HPLC for analysis (Agilent XDB-C18). Area under curves of peaks corresponding to CNP variants were measured and plotted as % of control.

In a first set of experiments, various CNP variants were tested to evaluate their sensitivity to NEP degradation. The variants tested were CNP22 (SEQ ID NO: 4); CNP variants having a D6 bone-targeting moiety, including D6-14AAlinker-CNP [C3] (SEQ ID NO: 147) and CNP-14AAlinker-D6 [C4] (SEQ ID NO: 148); CDNP-derived variants, including CNP-Nterm2 [C5] (SEQ ID NO: 150), CDNP—S3A4A5R6 [C13] (SEQ ID NO: 115), CDNP29-S3A4A5R6 [C14] (SEQ ID NO: 151), C2(E6) [BC2] (SEQ ID NO: 130), and C3 (E6) [BC3] (SEQ ID NO: 131); and a CNP variant having a generic cathepsin cleavage sequence, including KB1(E6) (SEQ ID NO: 155), and as shown in FIG. 34. Results are shown in FIG. 35A and in Table 14.

Overall, these results show that C4 peptides showed sensitivity to NEP degradation in vitro. Nevertheless, they are more resistant than CNP22 since 75% of C4 were still intact after 240 minutes incubation with NEP.

TABLE 14 Peptides % of control after 240 min CNP22 0 D6-14AAlinker-CNP [C3] 101 CNP-14AAlinker-D6 [C4] 75 CNP-Nterm2 [C5] 106 CDNP-S3A4A5R6 [C13] 100 CDNP29-S3A4A5R6 [C14] 99 KB1(E6) 107 C2(E6) [BC2] 101 C3(E6) [BC3] 100

In a second set of experiments, various CNP variants having an E6 bone-targeting moiety were tested to evaluate their sensitivity to NEP degradation. The variants tested were CNP22 (SEQ ID NO: 4), as control; a CNP variant having a specific cathepsin K cleavage sequence, including KA1(E6) (SEQ ID NO: 153); and CNP variants having an E6 bone-targeting moiety and a (Gly)_(p)[(Ser)(Gly)_(m)]_(n) linker, including C1(E6) and C4(E6) to C11(E6) [BC1 and BC4 to BC11] (SEQ ID NOs: 129 and 132-139), and as shown in FIG. 34. Results are shown in FIG. 35B and in Table 15. These results show that, in the conditions of this assay, all the tested CNP variants were completely resistant to NEP degradation in vitro.

TABLE 15 Peptides % of control after 240 min CNP22 0 KA1(E6) 108 C1(E6) [BC1] 99 C4(E6) [BC4] 94 C5(E6) [BC5] 100 C6(E6) [BC6] 98 C7(E6) [BC7] 98 C8(E6) [BC8] 103 C9(E6) [BC9] 98 C10(E6) [BC10] 102 C11(E6) [BC11] 102

Example 16 Potency of CNP Variants

To determine potency, peptides were tested for their ability to generate cGMP in a NPR-B whole cell dose response assay. Various peptides having a bone-targeting moiety were tested for potency using a whole cell cGMP assay, as described above in Example 2. These results are shown in Table 16. The rescue ratio is defined as the agonist concentration needed to produce cGMP at the same level as 2.4 nM of CNP22 (lower value) and 14 nM of CNP22 (high value).

TABLE 16 Resist EC₅₀ Rescue NEP Ratio Rescue Ratio Rescue degradation EC₅₀ versus % range versus Ratio Peptide N (No/Yes) (nM) CNP22 Efficacy (nM) CNP22 Average CNP22 8 No 14.7 ± 3.4 1.00 100 2.4-14   1 1 KB1(E6) 1 Yes 84.51 5.75 109 13.4-78.1  5.6-5.6 5.6 KA1(E6) 2 Yes 143.85 9.79 108 21.6-102   9.0-7.3 8.2 C4(E6) [BC4] 1 Yes 302 20.5 136 46-219 19-16 18 C8(E6) [BC8] 1 Yes 719 48.9 97 116-779  48-56 52 C6(E6) [BC6] 1 Yes 672.3 45.7 88 132-973  55-70 63 C7(E6) [BC7] 1 Yes 1009 68.6 95 177-1193 74-85 80 C9(E6) [BC9] 1 Yes 1166 79.3 95 183-1358 76-97 87 C10(E6) [BC10] 1 Yes 2474 168 156 213-1253 89-90 90 C11(E6) [BC11] 1 Yes 888.3 60.4 95 289-1662 120-119 120 C1(E6) [BC1] 1 Yes 1737 118 97 289-1733 120-124 122 C5(E6) [BC5] 1 Yes 2364 161 96 334-1899 139-136 138 C3(E6) [BC3] 1 Yes 990.1 67.4 67 280-3927 117-281 199 CNP-14AA 1 Yes 2144 146 156  900-10000 375-714 545 linker-D6 [C4] C2(E6) [BC2] 1 Yes 719.8 49.0 97  424-20000  177-1429 803

As can be seen from these results, potency was improved by introducing a cathepsin cleavage site between the E6 moiety and CNP. For example, KA1(E6) and KB1(E6) are more potent than the other tested peptides, where KA1(E6) has a specific cathepsin K cleavage site and KB1(E6) has a general cathepsin cleavage site. Inclusion of the KGANKK sequence, or a variant thereof, can improve potency.

Example 17 Stability and Potency of NC2st Variants

NC2st variants may be varied in several respects, as described herein and in Example 6, while maintaining stability and potency. Naturally-occurring homologs of CNP are cleaved by neutral endopeptidase enzyme (NEP) and insulin degrading enzyme (IDE) in a cellular environment. Degradation by one of these enzymes could result in inactivating the ability of the natriuretic peptide to raise intracellular cGMP. Accordingly, various NC2st variants (FcCNP fusion proteins) were tested for their stability by determining cGMP generation after exposure to NEP or IDE.

The following variants were tested for stability with NEP or IDE: NC2-KGANKK (SEQ ID NO: 512), NC2B-L17 (SEQ ID NO: 530, where X is L), and NC2-KGANKK-L17 (SEQ ID NO: 572, NC2-KL), where CNP22 is provided as a control.

To evaluate stability of fusion proteins compared to CNP22, the following protocol was used for both neutral endopeptidase enzyme (NEP) and insulin degrading enzyme (IDE) assays. For the NEP assay, equimolar amounts of fusion proteins (60 μM) and CNP22 (120 μM) were incubated for 0, 30, or 120 min. at 37° C. with 1.25 ng/μL of purified NEP (R&D Systems) in an assay buffer (25 mM sodium phosphate, 150 mM NaCl, pH 7.4) in eppendorf tubes. For the IDE assay, equimolar amounts of fusion proteins (60 μM) and CNP22 (120 μM) were incubated for 0, 30, or 120 min. at 37° C. with 3 ng/μL of purified IDE (R&D Systems) in an assay buffer (25 mM sodium phosphate, 150 mM NaCl, pH 7.4) in eppendorf tubes. Following incubation, the tubes were placed on ice. Samples were then tested for their ability to activate cyclic GMP production through NPRB activation. HEK293 cells stably expressing human NPRB receptor were incubated with equally potent doses of CNP22, NC2-KGANKK, or NC2-KL (10 nM), or NC2B-L17 (300 nM) from each sample for 40 minutes. cGMP production was measured using a cGMP HTRF assay (Cisbio bioassays). Assay was performed in triplicate, and measured cGMP values were similar for all control samples.

As shown in FIG. 36A for NEP, incubation of CNP22 with purified NEP for 30 min. and 120 min. reduced its ability to generate cGMP by 50% and 87%, respectively. In contrast, NC2-KGANKK and NC2-KL still generated comparable levels of cGMP, even when incubated for 2 hours with NEP. NC2B-L 17 was slightly affected by incubation with NEP, reducing its ability to generate cGMP by 25%.

As shown in FIG. 36B for IDE, incubation of CNP22 with purified IDE for 30 min. and 120 min. reduced its ability to generate cGMP by 64% and 99%, respectively. In contrast, all three FcCNP fusion proteins still generated comparable levels of cGMP even when incubated for 2 hours with IDE.

Taken together, these data for degradation studies suggest that FcCNP proteins are poor substrates for NEP and IDE, and may explain, at least in part, why these fusion proteins have highly increased half-lives in vivo compared to CNP22.

NC2st variants shown in FIG. 18 (NC2-KGANKK (SEQ ID NO:512) and NC2-KGANQK (SEQ ID NO: 514), without signal sequences) were tested for potency using a whole cell cGMP assay, as described above in Example 2. As provided in FIG. 37A, the results show that NC2-CNP53mut2, NC2-KGANKK, and NC2-KGANQK have improved potency compared to NC2B (SEQ ID NO: 504, as shown in FIG. 15A). In particular, NC2-KGANKK is the most potent of all the proteins provided in FIG. 37A.

NC2st variants may also be varied by including point mutations of CNP22 at position 17. An NC2st variant having leucine at position 17 of CNP22, as shown in FIG. 41A (NC2B-L17 (SEQ ID NO: 530, where X is L), without a signal sequence) was tested for potency using a whole cell cGMP assay, as described above in Example 2. As provided in FIG. 37B, the results show that substitution of methionine for leucine at position 17 of CNP22 does not significantly reduce the potency of NPR-B activation, as compared to NC2B.

Additional data for NC2st variants without a signal sequence are provided below in Table 17, including NC2B (SEQ ID NO: 504); a peptide having a bone-targeting moiety, i.e., D10-NC2 (SEQ ID NO: 608); NC2B peptides having a point mutation at position 17 of CNP22, i.e., NC2B-L17, NC2B-F17, NC2B-117, and NC2B-T17 (SEQ ID NO: 530, where X is L, F, I, or T, respectively); variants NC2-KGANKK and NC2-KGANQK (SEQ ID NOs: 512 and 514, respectively); and NC2-CNP53mut2 (SEQ ID NO: 516). The rescue ratio is defined as the agonist concentration needed to produce cGMP at the same level as 2.4 nM of CNP22 (lower value) and 14 nM of CNP22 (high value). The X in “rescue range” indicates that the dose at which the agonist can induce a cGMP production similar to 14 nM CNP22 cannot be determined because the agonist produced less cGMP.

TABLE 17 EC₅₀ Rescue Ratio Rescue Ratio EC₅₀ versus range versus Proteins N (nM) CNP22 % Efficiency (nM) CNP22 NC2B 8 818 55.7 88 187-1134 79 ± 22 D10-NC2 7 782 53.2 80 157-1023 69 ± 23 NC2B-L17 2 1015 69.1 111 133-805  57 ± 6.8 NC2B-F17 1 407 27.7 48 379-X 156 NC2B-I17 1 2844 194 110 395-2305 165 NC2B-T17 1 1608 109 62 918-X 383 NC2- 4 29 1.97 115  4.8-29 2.0 ± 0.8 KGANKK NC2- 2 170 11.6 116  18-118 7.9 ± 0.8 CNP53mut2 NC2- 3 167 11.4 98  29-187  13 ± 2.4 KGANQK

Accordingly, any of the sequences described herein can be modified to include KGANKK (SEQ ID NO: 314) or a variant thereof (e.g., KGANQK (SEQ ID NO: 315), KGANKQ (SEQ ID NO: 316), KGANQQ (SEQ ID NO: 317), QGANKK (SEQ ID NO: 318), QGANQK (SEQ ID NO: 319), QGANKQ (SEQ ID NO: 320), or QGANQQ (SEQ ID NO: 321)) as N-terminal extensions, C-terminal extensions, and/or linkers for any of the NPs disclosed herein; to include a bone-targeting moiety, such as a series of consecutive Asp or Glu residues, e.g., E₆, E₇, E₈, E₉, E₁₀, E₁₁, E₁₂, E₁₃, E₁₄, E₁₅, E₁₆, D₆, D₇, D₈, D₉, D₁₀, D₁₁, D₁₂, D₁₃, D₁₄, D₁₅, or D₁₆; to include a linker comprising GGGDLQVDTQSQAAWAQLL QEHPNAQQYKGANKK (SEQ ID NO: 330) or a fragment thereof; and/or to include a point mutation at position 17 of CNP22, such as a mutation at position 17 from methionine to phenylalanine, leucine, isoleucine, threonine, cysteine, proline, or aspartic acid.

Example 18 Exemplary Point Mutations of CNP22 at Position 17

Variants of CNP22, or polypeptides containing same, may be designed having a point mutation at position 17 relative to CNP22. As described herein, e.g., in Examples 11 and 15, this mutation can impart stability against degradation by oxidation and/or NEP cleavage without substantially reducing potency or efficacy. Further modifications include a variant having a bone-targeting moiety and variants having both a bone-targeting moiety and a linker, e.g., a flexible linker, between the bone-targeting moiety and the NP, where exemplary bone-targeting moieties and linkers are described herein.

Exemplary CNP variants having a point mutation at position 17 are shown in FIG. 38 (SEQ ID NOs: 126, 119-122, and 156-172), where X in SEQ ID NOs: 126 or 162 can be any amino acid, e.g., F, L, I, T, E, R, Y, C, P, or D. For example, in one embodiment of any of the sequences shown in FIG. 38, X is phenylalanine (Phe, F). In one embodiment of any of the sequences shown in FIG. 38, X is leucine (Leu, L). In one embodiment of any of the sequences shown in FIG. 38, X is isoleucine (Ile, I). In one embodiment of any of the sequences shown in FIG. 38, X is threonine (Thr, T). In one embodiment of any of the sequences shown in FIG. 38, X is glutamic acid (Glu, E). In one embodiment of any of the sequences shown in FIG. 38, X is arginine (Arg, R). In one embodiment of any of the sequences shown in FIG. 38, X is tyrosine (Tyr, Y). In one embodiment of any of the sequences shown in FIG. 38, X is cysteine (Cys, C). In one embodiment of any of the sequences shown in FIG. 38, X is proline (Pro, P). In one embodiment of any of the sequences shown in FIG. 38, X is aspartic acid (Asp, D). In one embodiment of any of the sequences shown in FIG. 38, X is glycine (Gly, G). In one embodiment of any of the sequences shown in FIG. 38, X is alanine (Ala, A). In one embodiment of any of the sequences shown in FIG. 38, X is serine (Ser, S). In one embodiment of any of the sequences shown in FIG. 38, X is valine (Val, V). In one embodiment of any of the sequences shown in FIG. 38, X is tryptophan (Trp, W). In one embodiment of any of the sequences shown in FIG. 38, X is asparagine (Asn, N). In one embodiment of any of the sequences shown in FIG. 38, X is glutamine (Gln, Q). In one embodiment of any of the sequences shown in FIG. 38, X is histidine (His, H). In one embodiment of any of the sequences shown in FIG. 38, X is lysine (Lys, K).

Variants of the molecules shown in FIG. 38 or otherwise described herein may also be utilized, e.g., lacking the bone-targeting moiety, or containing a different bone-targeting moiety. For example, any of E₆, E₇, E₈, E₉, E₁₀, E₁₁, E₁₂, E₁₃, E₁₄, E₁₅, E₁₆, D₆, D₇, D₈, D₉, D₁₀, D₁₁, D₁₂, D₁₃, D₁₄, D₁₅, or D₁₆ may be used as a bone-targeting moiety. A linker, e.g., a flexible linker, may be included between the bone-targeting moiety and the NP. For example, FIGS. 39A-39B provide variants having a linker or both a bone-targeting moiety and a linker, where X in any one of SEQ ID NOs: 173-210 can be any amino acid, e.g., F, L, I, T, E, R, Y, C, P, or D. For example, in one embodiment of any of the sequences shown in FIGS. 39A-39B having a linker or both a bone-targeting moiety and a linker, X is phenylalanine (Phe, F). In one embodiment of any of the sequences shown in FIGS. 39A-39B having a linker or both a bone-targeting moiety and a linker, X is leucine (Leu, L). In one embodiment of any of the sequences shown in FIGS. 39A-39B having a linker or both a bone-targeting moiety and a linker, X is isoleucine (Ile, I). In one embodiment of any of the sequences shown in FIGS. 39A-39B having a linker or both a bone-targeting moiety and a linker, X is threonine (Thr, T). In one embodiment of any of the sequences shown in FIGS. 39A-39B having a linker or both a bone-targeting moiety and a linker, X is glutamic acid (Glu, E). In one embodiment of any of the sequences shown in FIGS. 39A-39B having a linker or both a bone-targeting moiety and a linker, X is arginine (Arg, R). In one embodiment of any of the sequences shown in FIGS. 39A-39B having a linker or both a bone-targeting moiety and a linker, X is tyrosine (Tyr, Y). In one embodiment of any of the sequences shown in FIGS. 39A-39B, X is cysteine (Cys, C). In one embodiment of any of the sequences shown in FIGS. 39A-39B having a linker or both a bone-targeting moiety and a linker, X is proline (Pro, P). In one embodiment of any of the sequences shown in FIGS. 39A-39B having a linker or both a bone-targeting moiety and a linker, X is aspartic acid (Asp, D). In one embodiment of any of the sequences shown in FIGS. 39A-39B having a linker or both a bone-targeting moiety and a linker, X is glycine (Gly, G). In one embodiment of any of the sequences shown in FIGS. 39A-39B having a linker or both a bone-targeting moiety and a linker, X is alanine (Ala, A). In one embodiment of any of the sequences shown in FIGS. 39A-39B having a linker or both a bone-targeting moiety and a linker, X is serine (Ser, S). In one embodiment of any of the sequences shown in FIGS. 39A-39B having a linker or both a bone-targeting moiety and a linker, X is valine (Val, V). In one embodiment of any of the sequences shown in FIGS. 39A-39B having a linker or both a bone-targeting moiety and a linker, X is tryptophan (Trp, W). In one embodiment of any of the sequences shown in FIGS. 39A-39B having a linker or both a bone-targeting moiety and a linker, X is asparagine (Asn, N). In one embodiment of any of the sequences shown in FIGS. 39A-39B having a linker or both a bone-targeting moiety and a linker, X is glutamine (Gln, Q). In one embodiment of any of the sequences shown in FIGS. 39A-39B having a linker or both a bone-targeting moiety and a linker, X is histidine (His, H). In one embodiment of any of the sequences shown in FIGS. 39A-39B having a linker or both a bone-targeting moiety and a linker, X is lysine (Lys, K).

In addition, FIG. 40 provides amino acid sequences for particular variants, where X in SEQ ID NOs: 186-198 is a leucine to provide the sequences in SEQ ID NOs: 221-233.

Any of the molecules shown in FIGS. 38, 39A-39B, and 40, with or without the bone-targeting moiety, may be fused to an Fc domain and may optionally further include a linker region between the Fc and NP, as disclosed herein. For example, a CNP variant with M17X mutation can be fused to an Fc domain, e.g., as shown in FIGS. 41A-41E, where X can be any amino acid, e.g., F, L, I, T, E, R, Y, C, P, or D. For example, in one embodiment of any of the sequences shown in FIGS. 41A-41E, X is phenylalanine (Phe, F). In one embodiment of any of the sequences shown in FIGS. 41A-41E, X is leucine (Leu, L). In one embodiment of any of the sequences shown in FIGS. 41A-41E, X is isoleucine (Ile, I). In one embodiment of any of the sequences shown in FIGS. 41A-41E, X is threonine (Thr, T). In one embodiment of any of the sequences shown in FIGS. 41A-41E, X is glutamic acid (Glu, E). In one embodiment of any of the sequences shown in FIGS. 41A-41E, X is arginine (Arg, R). In one embodiment of any of the sequences shown in FIGS. 41A-41E, X is tyrosine (Tyr, Y). In one embodiment of any of the sequences shown in FIGS. 41A-41E, X is cysteine (Cys, C). In one embodiment of any of the sequences shown in FIGS. 41A-41E, X is proline (Pro, P). In one embodiment of any of the sequences shown in FIGS. 41A-41E, X is aspartic acid (Asp, D). In one embodiment of any of the sequences shown in FIGS. 41A-41E, X is glycine (Gly, G). In one embodiment of any of the sequences shown in FIGS. 41A-41E, X is alanine (Ala, A). In one embodiment of any of the sequences shown in FIGS. 41A-41E, X is serine (Ser, S). In one embodiment of any of the sequences shown in FIGS. 41A-41E, X is valine (Val, V). In one embodiment of any of the sequences shown in FIGS. 41A-41E, X is tryptophan (Trp, W). In one embodiment of any of the sequences shown in FIGS. 41A-41E, X is asparagine (Asn, N). In one embodiment of any of the sequences shown in FIGS. 41A-41E, X is glutamine (Gln, Q). In one embodiment of any of the sequences shown in FIGS. 41A-41E, X is histidine (His, H). In one embodiment of any of the sequences shown in FIGS. 41A-41E, X is lysine (Lys, K).

In some embodiments, the sequence is SEQ ID NO: 530, and X is any amino acid described herein. In one embodiment, the sequence is SEQ ID NO: 530, and X is phenylalanine (Phe, F). In one embodiment, the sequence is SEQ ID NO: 530, and X is leucine (Leu, L). In one embodiment, the sequence is SEQ ID NO: 530, and X is isoleucine (Ile, I). In one embodiment, the sequence is SEQ ID NO: 530, and X is threonine (Thr, T). In one embodiment, the sequence is SEQ ID NO: 530, and X is glutamic acid (Glu, E). In one embodiment, the sequence is SEQ ID NO: 530, and X is arginine (Arg, R). In one embodiment, the sequence is SEQ ID NO: 530, and X is tyrosine (Tyr, Y). In one embodiment, the sequence is SEQ ID NO: 530, and X is cysteine (Cys, C). In one embodiment, the sequence is SEQ ID NO: 530, and X is proline (Pro, P). In one embodiment, the sequence is SEQ ID NO: 530, and X is aspartic acid (Asp, D). In one embodiment, the sequence is SEQ ID NO: 530, and X is glycine (Gly, G). In one embodiment, the sequence is SEQ ID NO: 530, and X is alanine (Ala, A). In one embodiment, the sequence is SEQ ID NO: 530, and X is serine (Ser, S). In one embodiment, the sequence is SEQ ID NO: 530, and X is valine (Val, V). In one embodiment, the sequence is SEQ ID NO: 530, and X is tryptophan (Trp, W). In one embodiment, the sequence is SEQ ID NO: 530, and X is asparagine (Asn, N). In one embodiment, the sequence is SEQ ID NO: 530, and X is glutamine (Gln, Q). In one embodiment, the sequence is SEQ ID NO: 530, and X is histidine (His, H). In one embodiment, the sequence is SEQ ID NO: 530, and X is lysine (Lys, K).

Example 19 Exemplary NC2B Variants

NC2B may be varied in several respects, including having a point mutation, e.g., at position 17 relative to CNP22, having a bone-targeting moiety, and/or having modified or altered linker regions. Exemplary variants are provided below.

As shown in FIG. 42A and described above in Example 6, variants include those having modified or altered linker region, as compared to NC2B (as shown in FIGS. 15A-15B). In addition, variants also include any sequences having a bone-targeting moiety, e.g., a D₁₀ moiety, and exemplary sequences are provided in FIG. 42B (SEQ ID NOs: 553-558). In addition, the italicized regions in FIGS. 38, 39A-39B, and 40 may be used as N-terminal extensions, C-terminal extensions, and/or linkers for any of the NPs disclosed herein (e.g., SEQ ID NOs: 511-516 and 553-558). Any of SEQ ID NOs: 511-516 and 553-558 can be used in a method to treat any condition herein. In particular embodiments, one or more of SEQ ID NOs: 511-516 and 553-558 are used in a method to treat achondroplasia.

As shown in FIG. 42C, position 17 relative to CNP22 is substituted with a phenylalanine (Phe, F) in SEQ ID NOs: 537-542 to provide the sequences in SEQ ID NOs: 559-564. As shown in FIG. 42D, these sequences can be further modified to include a D₁₀ bone-targeting moiety at the N-terminus to provide the sequences in SEQ ID NOs: 565-570. In addition, the italicized regions in FIGS. 38, 39A-39B, and 40 may be used as N-terminal extensions, C-terminal extensions, and/or linkers for any of the NPs disclosed herein (e.g., SEQ ID NOs: 559-570). Any of SEQ ID NOs: 559-570 can be used in a method to treat any condition herein. In particular embodiments, one or more of SEQ ID NOs: 559-570 are used in a method to treat achondroplasia.

As shown in FIG. 42E, position 17 relative to CNP22 is substituted with a leucine (Leu, L) in SEQ ID NOs: 537-542 to provide the sequences in SEQ ID NOs: 571-576. As shown in FIG. 42F, these sequences can be further modified to include a D₁₀ bone-targeting moiety at the N-terminus to provide the sequences in SEQ ID NOs: 577-582. In addition, the italicized regions in FIGS. 38, 39A-39B, and 40 may be used as N-terminal extensions, C-terminal extensions, and/or linkers for any of the NPs disclosed herein (e.g., SEQ ID NOs: 571-582). Any of SEQ ID NOs: 571-582 can be used in a method to treat any condition herein. In particular embodiments, one or more of SEQ ID NOs: 571-582 are used in a method to treat achondroplasia.

As shown in FIG. 42G, position 17 relative to CNP22 is substituted with a arginine (Arg, R) in SEQ ID NOs: 537-542 to provide the sequences in SEQ ID NOs: 583-588. As shown in FIG. 42H, these sequences can be further modified to include a D₁₀ bone-targeting moiety at the N-terminus to provide the sequences in SEQ ID NOs: 589-594. In addition, the italicized regions in FIGS. 38, 39A-39B, and 40 may be used as N-terminal extensions, C-terminal extensions, and/or linkers for any of the NPs disclosed herein (e.g., SEQ ID NOs: 583-594). Any of SEQ ID NOs: 583-594 can be used in a method to treat any condition herein. In particular embodiments, one or more of SEQ ID NOs: 583-594 are used in a method to treat achondroplasia.

As shown in FIG. 42I, position 17 relative to CNP22 is substituted with a tyrosine (Tyr, Y) in SEQ ID NOs: 537-542 to provide the sequences in SEQ ID NOs: 595-600. As shown in FIG. 42J, these sequences can be further modified to include a D₁₀ bone-targeting moiety at the N-terminus to provide the sequences in SEQ ID NOs: 601-606. In addition, the italicized regions in FIGS. 38, 39A-39B, and 40 may be used as N-terminal extensions, C-terminal extensions, and/or linkers for any of the NPs disclosed herein (e.g., SEQ ID NOs: 595-606). Any of SEQ ID NOs: 595-606 can be used in a method to treat any condition herein. In particular embodiments, one or more of SEQ ID NOs: 595-606 are used in a method to treat achondroplasia.

Example 20 Effects of NC2B on Arterial Blood Pressure in Mice

To determine potential side effects of the fusion protein, we assessed the hemodynamic effects of NC2B on systolic, diastolic, and mean arterial blood pressures before and after subcutaneous (SC) administration of NC2B in telemetrized conscious wild-type mice.

Doses ranged from 0 to 100 mg/kg and were selected with respect to in vivo effect on bone growth. Six male c57BL/6J mice aged between 12 and 13 weeks old were included in each treatment group. NC2B administration was performed subcutaneously, once a day over 5 consecutive days, in non-anesthetized mice. Arterial blood pressures were acquired via surgically-implanted pressure transducers, positioned in the left carotid artery. For each mouse, the average of arterial blood pressures 30 minutes prior to daily injection was recorded as the reference and subtracted from the values at other time points to obtain hemodynamic response. Telemetry data analysis was based on average change over the 5 consecutive injection days for each individual mice, since no signs of cumulative or additive effects nor any habituation or tolerance were observed following separate analysis of each injection day.

As shown in FIGS. 43A-43C, NC2B induced hemodynamic effects and displayed a dose-response relationship when injected SC. These hypotensive effects are considered limited and within an acceptable hemodynamic range at all tested doses following SC administration. Accordingly, any of the sequences described herein can be assayed for possible dose-dependent side effects, such as adverse hemodynamic effects including lowering of blood pressure, and administered in a dosage range (e.g., any described herein) to minimize such side effects or to reduce these side effects, as compared to a control (e.g., any described herein).

Example 21 Evaluation of a Weekly Bolus Subcutaneous Injection of NC2B on Bone Growth in Wild-Type (Cd-1) Mice

Objective

The study was designed to evaluate the effect of weekly subcutaneous (SC) administration of NC2B on bone growth in wild-type (WT) mice.

Test Article

Test article: NC2B formulated in 25 mM sodium phosphate, 150 mM NaCl, pH 7.4.

Control article: Vehicle, 25 mM sodium phosphate, 150 mM NaCl, pH 7.4.

Test System

CD-1 mice are a standard rodent species for use in pharmacodynamic studies, and these mice are described above in Example 14.

Experimental Design

The animals received NC2B as a subcutaneous injection into the interscapular region as described in Table 18 below.

TABLE 18 Total Duration amount WT of Dose received (CD-1, Group Group treatment Dosing Level (mg/kg female) No. description ROA (days) Interval (mg/kg) (nmol/kg)) N = 1 V SC 35 Once 0    0 16 injection daily    (0) 2 Tx-30-QD SC 35 Once 30 1,050 16 injection daily (18,235)  3 Tx-30-QW SC 35 Once 30   150 16 injection weekly (2,605) 4 Tx-100-QW SC 35 Once 100   500 16 injection weekly (8,690) 5 Tx-200-QW SC 35 Once 200 1,000 16 injection weekly (17,380)  6 Tx-100- SC 5 Once 100   500 16 5QD* injection daily (8,690) ROA: route of administration *The dosing regimen for Tx-100-5QD was daily for 5 consecutive days (Day 1 to Day 5 of the study), followed by 30 days of recovery (Day 6 to Day 35). Necropsy followed on Day 36.

CD-1 mice were treated at 3 weeks old at the indicated doses for 35 consecutive days, followed by necropsy 24 hours after the last injection.

Experimental Procedures

Experiments were conducted as described above in Example 14.

Results

Experimental results are shown in FIGS. 44A-44B and are summarized in Table 19 (results at day 36) below. Data in Table 19 were obtained at necropsy with a caliper, unless otherwise noted.

TABLE 19 Tx-30- Tx-30- Tx-100- Tx-200- Tx-100- Length measurement^(a) V QD QW QW QW 5QD Left Tibia length (mm)  17.8^(#)  18.7*  18.4*  18.3  18.5*  18.4* Δ —  0.9  0.6  0.5  0.7  0.6 % Δ —  5.1  3.4  2.8  3.9  3.4 Left Femur length (mm)  15.0^(#)  16.2*  15.6*^(#)  15.6*^(#)  15.8*  15.3^(#) Δ —  1.2  0.6  0.6  0.8  0.3 % Δ —  8.0  4.0  4.0  5.3  2.0 Left Ulna length (mm)  14.0^(#)  14.9*  14.4  14.4  14.3^(#)  14.4 Δ —  0.9  0.4  0.4  0.3  0.4 % Δ —  6.4  2.9  2.9  2.1  2.9 Left Humerus length (mm)  12.2^(#)  12.8*  12.6*  12.6*  12.6*  12.4^(#) Δ —  0.6  0.4  0.4  0.4  0.2 % Δ —  4.9  3.3  3.3  3.3  1.6 Naso-anal length (mm, X-Ray) 108^(#) 120* 114*^(#) 115*^(#) 117* 112^(#) Δ —  12  6.0  7.0  9.0  4.0 % Δ —  11.1  5.6  6.5  8.3  3.7 Crown-rump length in vivo (mm,  97.9^(#) 106* 103* 103* 104* 101^(#) ruler) Δ —  8.1  5.1  5.1  6.1  3.1 % Δ —  8.3  5.2  5.2  6.2  3.2 Total CTL^(b) segments (mm, X-  51.0^(#)  57.9*  54.4*^(#)  54.5*^(#)  55.9*^(#)  53.0*^(#) Ray) Δ —  6.9  3.4  3.5  4.9  2.0 % Δ —  13.5  6.7  6.9  9.6  3.9 Tail length in vivo (mm, ruler)  99.1^(#) 109* 104* 104* 107* 104*^(#) Δ —  9.9  4.9  4.9  7.9  4.9 % Δ —  10.0  4.9  4.9  8.0  4.9 ^(a)Δ and % Δ compared to Vehicle ^(b)Cervical, thoracic, and lumbar *Significant compared with Vehicle, P < 0.05 ^(#)Significant compared with Tx-30-QD, P < 0.05

Both NC2B daily and weekly therapeutic regimens induced robust growth of almost all bone lengths (axial and appendicular) after a 35-day treatment period in wild-type mice. As shown in Tables 13 and 19, NC2st and NC2B at 30 mg/kg daily have similar efficacy on bone growth in mice. These data confirm that a weekly dosing regimen is sufficient for Fc-CNP fusion protein to induce significant bone growth.

REFERENCES

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Other Embodiments

All publications, patent applications, and patents mentioned in this specification are herein incorporated by reference in their entirety.

While the invention has been described in connection with specific embodiments, it will be understood that it is capable of further modifications. Therefore, this application is intended to cover any variations, uses, or adaptations of the invention that follow, in general, the principles of the invention, including departures from the present disclosure that come within known or customary practice within the art. 

1. An isolated polypeptide comprising the structure X-Fc-Y—NP—Z or the structure X—NP—Y-Fc-Z, wherein NP is a natriuretic peptide that is an agonist of natriuretic peptide receptor B (NPR-B), and wherein either: (i) NP comprises amino acids 6-22 of SEQ ID NO: 126, wherein the amino acid at position 17 is not Met; and each of X, Y, and Z is, independently, absent or is an amino acid sequence of at least one amino acid; or (ii) each of X and Z is, independently, absent or is an amino acid sequence of at least one amino acid; and the amino acid sequence of Y comprises [(Gly)₄(Ser)]_(n)(Gly)_(p) or (Gly)_(p)[(Ser)(Gly)₄]_(n), wherein n is between 1 and 10 and p is between 0 and 4, or wherein the amino acid sequence of Y comprises the amino acid sequence of any one of SEQ ID NOs: 304-313, 322-333, or 337-389.
 2. The isolated polypeptide of claim 1, wherein said polypeptide comprises the structure X-Fc-Y—NP-Z.
 3. The isolated polypeptide of claim 1, wherein: (i) NP comprises amino acids 6-22 of SEQ ID NO: 126, wherein the amino acid at position 17 is not Met; and each of X, Y, and Z is, independently, absent or is an amino acid sequence of at least one amino acid.
 4. The isolated polypeptide of claim 3, wherein the amino acid at position 17 of SEQ ID NO: 126 is Phe, Leu, Ile, Thr, Val, Ala, or Ser.
 5. The isolated polypeptide of claim 3, wherein the amino acid at position 17 of SEQ ID NO: 126 is Phe, Leu, Ile, Thr, Glu, Arg, Tyr, Cys, Pro, or Asp.
 6. The isolated polypeptide of claim 5, wherein the amino acid at position 17 of SEQ ID NO: 126 is Phe or Leu.
 7. The isolated polypeptide of claim 7, wherein the amino acid at position 17 of SEQ ID NO: 126 is Leu.
 8. The isolated polypeptide of claim 3, wherein said NP comprises the structure: [N-terminal extension]-[short segment]-[ring domain]-[C-terminal extension], wherein said ring domain comprises amino acids 6-22 of SEQ ID NO: 126, wherein the amino acid at position 17 is not Met, and each of said N-terminal extension, short segment, and C-terminal extension is, independently, absent or is an amino acid sequence of at least one amino acid.
 9. The isolated polypeptide of claim 1, wherein: (ii) each of X and Z is, independently, absent or is an amino acid sequence of at least one amino acid; and the amino acid sequence of Y comprises [(Gly)₄(Ser)]_(n)(Gly)_(p) or (Gly)_(p)[(Ser)(Gly)₄]_(n), wherein n is between 1 and 10 and p is between 0 and 4, or wherein the amino acid sequence of Y comprises the amino acid sequence of any one of SEQ ID NOs: 304-313, 322-333, or 337-389.
 10. The isolated polypeptide of claim 9, wherein said NP comprises the structure: [N-terminal extension]-[short segment]-[ring domain]-[C-terminal extension], wherein said ring domain comprises the amino acid sequence of SEQ ID NO: 6, amino acids 11-27 of SEQ ID NO: 30, or SEQ ID NO: 95, and each of said N-terminal extension, short segment, and C-terminal extension is, independently, absent or is an amino acid sequence of at least one amino acid.
 11. The isolated polypeptide of claim 10, wherein said ring domain comprises amino acids 6-22 of SEQ ID NO:
 126. 12. The isolated polypeptide of claim 11, wherein the amino acid at position 17 of SEQ ID NO: 126 is Phe, Leu, Ile, Thr, Val, Ala, or Ser.
 13. The isolated polypeptide of claim 11, wherein the amino acid at position 17 of SEQ ID NO: 126 is Phe, Leu, Ile, Thr, Glu, Arg, Tyr, Cys, Pro, or Asp.
 14. The isolated polypeptide of claim 13, wherein the amino acid at position 17 of SEQ ID NO: 126 is Phe or Leu.
 15. The isolated polypeptide of claim 14, wherein the amino acid at position 17 of SEQ ID NO: 126 is Phe.
 16. The isolated polypeptide of claim 14, wherein the amino acid at position 17 of SEQ ID NO: 126 is Leu.
 17. The isolated polypeptide of claim 10, wherein said ring domain comprises the amino acid sequence of SEQ ID NO:
 12. 18. The isolated polypeptide of claim 10, wherein said short segment and said ring domain together comprise the amino acid sequence of any one of SEQ ID NOs: 4 or 13-30.
 19. The isolated polypeptide of claim 8, wherein the amino acid sequence of said short segment consists of amino acids 1-5 of SEQ ID NO:
 4. 20. The isolated polypeptide of claim 8, wherein the amino acid sequence of said short segment consists of amino acids 1-5, 2-5, 3-5, 4-5, or 5 of SEQ ID NO: 4, amino acids 1-10 of SEQ ID NO: 17, amino acids 1-5 of SEQ ID NO: 19, amino acids 1-3 of SEQ ID NO: 20, amino acids 1-5 of SEQ ID NO: 21, or amino acids 1-6 of SEQ ID NO:
 29. 21. The isolated polypeptide of claim 10, wherein the amino acid sequence of said short segment and said ring domain together consists of the amino acid sequence of SEQ ID NO:
 4. 22. The isolated polypeptide of claim 10, wherein the amino acid sequence of said short segment and said ring domain together consists of the amino acid sequence of any one of SEQ ID NOs: 119-122, 126, or 156-161.
 23. The isolated polypeptide of claim 8, wherein the amino acid sequence of said N-terminal extension comprises amino acids 1-31 of SEQ ID NO:
 11. 24. The isolated polypeptide of claim 8, wherein the amino acid sequence of said N-terminal extension comprises amino acids 17-31 of SEQ ID NO:
 11. 25. The isolated polypeptide of claim 8, wherein the amino acid sequence of said N-terminal extension comprises KGANKK (SEQ ID NO: 314) or KGANQK (SEQ ID NO: 315).
 26. The isolated polypeptide of claim 10, wherein said N-terminal extension, short segment, and ring domain together comprise the amino acid sequence of SEQ ID NO:
 11. 27. The isolated polypeptide of claim 8, wherein said C-terminal extension comprises the amino acid sequence of SEQ ID NO:
 118. 28. The isolated polypeptide of claim 27, wherein said C-terminal extension comprises the amino acid sequence of SEQ ID NO: 117 or comprises amino acids 23-37 selected from any one of SEQ ID NOs: 101-116.
 29. The isolated polypeptide of claim 10, wherein the amino acid sequence of said NP consists of SEQ ID NO:
 4. 30. The isolated polypeptide of claim 10, wherein the amino acid sequence of said NP consists of SEQ ID NO:
 11. 31. The isolated polypeptide of claim 10, wherein the amino acid sequence of said NP consists of the amino acid sequence of any one of SEQ ID NOs: 31-94, or a fragment thereof comprising at least a ring domain.
 32. The isolated polypeptide of claim 3, wherein the amino acid sequence of said NP consists of the amino acid sequence of any one of SEQ ID NOs: 119-125 or 156-220, wherein position 17 relative to SEQ ID NO: 126 is not Met, or the amino acid sequence of any one of SEQ ID NOs: 221-233.
 33. The isolated polypeptide of claim 9, wherein the amino acid sequence of said NP consists of the amino acid sequence of any one of SEQ ID NOs: 13-29, 100-116, 119-125, 127-233, or 1001-1155.
 34. The isolated polypeptide of claim 1, wherein said NP is selective for NPR-B over NPR-A, wherein the EC_(50(NPR-A))/EC_(50(NPR-B)) ratio for said NP, as determined in an in vivo pharmacokinetic assay, is at least
 30. 35. The isolated polypeptide of claim 1, wherein said Fc comprises a C_(H2) domain, a C_(H3) domain, and a hinge region.
 36. The isolated polypeptide of claim 35, wherein said Fc is a constant domain of an immunoglobulin selected from the group consisting of IgG-1, IgG-2, IgG-3, IgG-3 and IgG-4.
 37. The isolated polypeptide of claim 35, wherein said Fc comprises the amino acid sequence of SEQ ID NO:
 401. 38. The isolated polypeptide of claim 36, wherein said immunoglobulin is IgG-1.
 39. The isolated polypeptide of claim 35, wherein the amino acid sequence of said Fc comprises an amino acid sequence having at least 85% sequence identity to SEQ ID NO:
 401. 40.-41. (canceled)
 42. The isolated polypeptide of claim 39, wherein the amino acid sequence of said Fc comprises SEQ ID NO:
 401. 43. The isolated polypeptide of claim 42, wherein the amino acid sequence of said Fc consists of SEQ ID NO:
 401. 44. The isolated polypeptide of claim 1, wherein Y comprises a glycine-rich region.
 45. The isolated polypeptide of claim 44, wherein the amino acid sequence of Y consists of one or more glycines and one or more serines.
 46. The isolated polypeptide of claim 44, wherein the amino acid sequence of Y comprises the amino acid sequence of any one of SEQ ID NOs: 304-313, 322-333, or 337-389.
 47. The isolated polypeptide of claim 3, wherein the amino acid sequence of Y comprises [(Gly)_(m)(Ser)]_(n)(Gly)_(p) or (Gly)_(p)[(Ser)(Gly)_(m)]_(n), wherein each of m, n, and p is, independently, between 0 and
 20. 48. The isolated polypeptide of claim 47, wherein combinations of m, n, and p are selected from a single row of Table
 1. 49. The isolated polypeptide of claim 1, wherein X is absent, Z is absent, or X and Z are both absent.
 50. The isolated polypeptide of claim 1, wherein X, Y, or Z comprises a bone-targeting moiety.
 51. The isolated polypeptide of claim 50, wherein said bone-targeting moiety comprises six consecutive acidic residues.
 52. The isolated polypeptide of claim 51, wherein said bone-targeting moiety comprises ten consecutive acidic residues.
 53. The isolated polypeptide of claim 51, wherein said acidic residues are aspartic acid or glutamic acid.
 54. The isolated polypeptide of claim 53, wherein said bone-targeting moiety comprises E₆, E₁₀, D₆, or D₁₀.
 55. The isolated polypeptide of claim 1, wherein X, Y, or Z comprises a cathepsin cleavage sequence.
 56. The isolated polypeptide of claim 55, wherein said cathepsin cleavage sequence comprises a cathepsin K cleavage sequence.
 57. The isolated polypeptide of claim 55, wherein said cathepsin cleavage sequence is HGPQG (SEQ ID NO: 374) or HKLRG (SEQ ID NO: 375).
 58. The isolated polypeptide of claim 1, wherein said polypeptide comprises the amino acid sequence of any one of SEQ ID NOs: 501-608.
 59. The isolated polypeptide of claim 58, wherein said polypeptide comprises the amino acid sequence of any one of SEQ ID NO: 502, SEQ ID NO: 504, SEQ ID NO: 506, SEQ ID NO: 512, SEQ ID NO: 514, SEQ ID NO: 516, SEQ ID NO: 560, SEQ ID NO: 562, SEQ ID NO: 564, SEQ ID NO: 572, SEQ ID NO: 574, SEQ ID NO: 576, SEQ ID NO: 584, SEQ ID NO: 586, SEQ ID NO: 588, SEQ ID NO: 596, SEQ ID NO: 598, SEQ ID NO: 600, or SEQ ID NO:
 608. 60. The isolated polypeptide of claim 59, wherein said polypeptide comprises a bone-targeting moiety.
 61. The isolated polypeptide of claim 60, wherein said bone-targeting moiety comprises E₆, E₁₀, D₆, or D₁₀. 62.-63. (canceled)
 64. The isolated polypeptide of claim 1, wherein the amino acid sequence of said polypeptide comprises the amino acid sequence of SEQ ID NO:
 512. 65. The isolated polypeptide of claim 64, wherein the amino acid sequence of said polypeptide consists of the amino acid sequence of SEQ ID NO:
 512. 66. The isolated polypeptide of claim 1, wherein the amino acid sequence of said polypeptide comprises the amino acid sequence of SEQ ID NO:
 554. 67. The isolated polypeptide of claim 66, wherein the amino acid sequence of said polypeptide consists of the amino acid sequence of SEQ ID NO:
 554. 68. The isolated polypeptide of claim 1, wherein the amino acid sequence of said polypeptide comprises the amino acid sequence of SEQ ID NO:
 572. 69. The isolated polypeptide of claim 68, wherein the amino acid sequence of said polypeptide consists of the amino acid sequence of SEQ ID NO:
 572. 70. The isolated polypeptide of claim 1, wherein the amino acid sequence of said polypeptide comprises the amino acid sequence of SEQ ID NO:
 578. 71. The isolated polypeptide of claim 70, wherein the amino acid sequence of said polypeptide consists of the amino acid sequence of SEQ ID NO:
 578. 72. The isolated polypeptide of claim 1, wherein the amino acid sequence of said polypeptide comprises the amino acid sequence of SEQ ID NO:
 560. 73. The isolated polypeptide of claim 72, wherein the amino acid sequence of said polypeptide consists of the amino acid sequence of SEQ ID NO:
 560. 74. The isolated polypeptide of claim 1, wherein the amino acid sequence of said polypeptide comprises the amino acid sequence of SEQ ID NO:
 566. 75. The isolated polypeptide of claim 74, wherein the amino acid sequence of said polypeptide consists of the amino acid sequence of SEQ ID NO:
 566. 76. The isolated polypeptide of claim 1, wherein the amino acid sequence of said polypeptide comprises the amino acid sequence of SEQ ID NO:
 538. 77. The isolated polypeptide of claim 76, wherein the amino acid sequence of said polypeptide consists of the amino acid sequence of SEQ ID NO:
 538. 78. The isolated polypeptide of claim 1, wherein said polypeptide has reduced degradation, as compared to a control.
 79. An isolated polypeptide comprising the structure V-NP-W, wherein NP is a natriuretic peptide that is an agonist of natriuretic peptide receptor B (NPR-B); each of V and W is, independently, absent or is an amino acid sequence of at least one amino acid; and said NP comprises the amino acid sequence of any one of SEQ ID NOs: 101-116, 119-122, 128-161, or 163-233, or V or W comprises the amino acid sequence of any one of SEQ ID NOs: 304-313, 322-333, or 337-389.
 80. An isolated polypeptide comprising the structure V-NP or NP-W, wherein NP is a natriuretic peptide that is an agonist of natriuretic peptide receptor B (NPR-B); and each of V and W comprises, independently, the amino acid sequence of any one of SEQ ID NOs: 304-313, 322-333, or 337-389. 81.-111. (canceled)
 112. The isolated polypeptide of claim 1, wherein said polypeptide is glycosylated.
 113. The isolated polypeptide of claim 1, wherein said polypeptide is pegylated.
 114. The isolated polypeptide of claim 1, comprising a bone-targeting moiety.
 115. The isolated polypeptide of claim 114, wherein said bone-targeting moiety comprises E₆, E₁₀, D₆, or D₁₀.
 116. The isolated polypeptide of claim 1, comprising a cathepsin cleavage sequence.
 117. The isolated polypeptide of claim 116, wherein said cathepsin cleavage sequence is HGPQG (SEQ ID NO: 374) or HKLRG (SEQ ID NO: 375).
 118. An isolated nucleic acid molecule encoding the polypeptide of claim
 1. 119. An isolated nucleic acid molecule comprising the nucleic acid sequence of any one of SEQ ID NOs: 801-806, or comprising a nucleic acid sequence encoding a polypeptide encoded by any one of SEQ ID NOs: 801-806. 120.-121. (canceled)
 122. An isolated recombinant host cell transformed or transfected with the isolated nucleic acid molecule of claim
 118. 123. (canceled)
 124. A pharmaceutical composition comprising: (a) the isolated polypeptide of claim 1; and (b) a pharmaceutically acceptable excipient.
 125. A pharmaceutical composition comprising: (a) the isolated nucleic acid molecule of claim 118; and (b) a pharmaceutically acceptable excipient. 126.-137. (canceled)
 138. A kit comprising: (a) the pharmaceutical composition of claim 124; and (b) instructions for administering said pharmaceutical composition to a subject to treat a disorder associated with overactivation of FGFR3, a bone or cartilage disorder, or a vascular smooth muscle disorder.
 139. (canceled)
 140. A kit comprising: (a) the pharmaceutical composition of claim 124; and (b) instructions for administering said pharmaceutical composition to a subject to elongate bone.
 141. A method of producing the polypeptide of claim 1, comprising culturing the host cell of claim 122 in a culture medium under conditions suitable to effect expression of the polypeptide and recovering said polypeptide from said culture medium. 142.-143. (canceled)
 144. A method of treating a disorder associated with overactivation of FGFR3, a bone or cartilage disorder, or a vascular smooth muscle disorder in a subject, said method comprising administering to said subject a therapeutically effective amount of a pharmaceutical composition of claim 124, thereby treating said disorder associated with overactivation of FGFR3, bone or cartilage disorder, or vascular smooth muscle disorder in said subject.
 145. The method of claim 144, comprising treating a disorder associated with overactivation of FGFR3.
 146. The method of claim 144, comprising treating a bone or cartilage disorder.
 147. The method of claim 146, wherein said bone or cartilage disorder is a skeletal dysplasia.
 148. The method of claim 147, wherein said skeletal dysplasia is selected from the group consisting of achondroplasia, homozygous achondroplasia, heterozygous achondroplasia, achondrogenesis, acrodysostosis, acromesomelic dysplasia, atelosteogenesis, camptomelic dysplasia, chondrodysplasia punctata, rhizomelic type of chondrodysplasia punctata, cleidocranial dysostosis, congenital short femur, craniosynostosis, dactyl), brachydactyl), camptodactyl), polydactyl), syndactyl), diastrophic dysplasia, dwarfism, dyssegmental dysplasia, enchondromatosis, fibrochondrogenesis, fibrous dysplasia, hereditary multiple exostoses, hypochondroplasia, hypophosphatasia, hypophosphatemic rickets, Jaffe-Lichtenstein syndrome, Kniest dysplasia, Kniest syndrome, Langer-type mesomelic dysplasia, Marfan syndrome, McCune-Albright syndrome, micromelia, metaphyseal dysplasia, Jansen-type metaphyseal dysplasia, metatrophic dysplasia, Morquio syndrome, Nievergelt-type mesomelic dysplasia, neurofibromatosis, osteoarthritis, osteochondrodysplasia, osteogenesis imperfecta, perinatal lethal type of osteogenesis imperfecta, osteopetrosis, osteopoikilosis, peripheral dysostosis, Reinhardt syndrome, Roberts syndrome, Robinow syndrome, short-rib polydactyl)-syndromes, short stature, spondyloepiphyseal dysplasia congenita, spondyloepimetaphyseal dysplasia, and thanatophoric dysplasia. 149-154. (canceled)
 155. The method of claim 145, wherein said disorder associated with overactivation of FGFR3 is cancer.
 156. The method of claim 155, wherein said cancer is selected from the group consisting of multiple myeloma, myeloproliferative syndrome, leukemia, plasma cell leukemia, lymphoma, glioblastoma, prostate cancer, bladder cancer, and mammary cancer.
 157. The method of claim 144, comprising treating a vascular smooth muscle disorder.
 158. The method of claim 157, wherein said vascular smooth muscle disorder is selected from the group consisting of hypertension, restenosis, arteriosclerosis, acute decompensated heart failure, congestive heart failure, cardiac edema, nephredema, hepatic edema, acute renal insufficiency, and chronic renal insufficiency.
 159. A method of elongating bone in a subject, said method comprising administering to said subject a therapeutically effective amount of a pharmaceutical composition of claim 124, thereby elongating bone in said subject.
 160. The method of claim 144, wherein said subject is human.
 161. The method of claim 144, wherein said pharmaceutical composition is administered subcutaneously, intravenously, orally, nasally, intramuscularly, sublingually, intrathecally, or intradermally. 162.-166. (canceled)
 167. A method of treating a disorder associated with overactivation of FGFR3, a bone or cartilage disorder, or a vascular smooth muscle disorder in a subject, said method comprising administering to said subject a therapeutically effective amount of a pharmaceutical composition comprising: (a) a polypeptide comprising the structure X-Fc-Y—NP-Z or the structure X—NP—Y-Fc-Z; and (b) a pharmaceutically acceptable excipient, wherein NP is a natriuretic peptide that is an agonist of natriuretic peptide receptor B (NPR-B); and each of X, Y, and Z is, independently, absent or is an amino acid sequence of at least one amino acid, thereby treating said disorder associated with overactivation of FGFR3, bone or cartilage disorder, or vascular smooth muscle disorder in said subject.
 168. A method of elongating bone in a subject, said method comprising administering to said subject a therapeutically effective amount of a pharmaceutical composition comprising: (a) a polypeptide comprising the structure X-Fc-Y—NP-Z or the structure X—NP—Y-Fc-Z; and (b) a pharmaceutically acceptable excipient, wherein NP is a natriuretic peptide that is an agonist of natriuretic peptide receptor B (NPR-B); and each of X, Y, and Z is, independently, absent or is an amino acid sequence of at least one amino acid, thereby elongating bone in said subject. 169.-204. (canceled)
 205. A method of treating a disorder associated with overactivation of FGFR3, a bone or cartilage disorder, or a vascular smooth muscle disorder in a subject, said method comprising administering to said subject a therapeutically effective amount of a pharmaceutical composition comprising: (a) a polypeptide comprising the structure V-NP-W; and (b) a pharmaceutically acceptable excipient, wherein NP is a natriuretic peptide that is an agonist of natriuretic peptide receptor B (NPR-B); each of V and W is, independently, absent or is an amino acid sequence of at least one amino acid; and said NP comprises the amino acid sequence of any one of SEQ ID NOs: 17-29, 31-40, 42-94, 101-116, 119-122, 128-161, or 163-233, or V or W comprises the amino acid sequence of any one of SEQ ID NOs: 304-313, 322-333, or 337-389, thereby treating said disorder associated with overactivation of FGFR3, bone or cartilage disorder, or vascular smooth muscle disorder in said subject.
 206. A method of elongating bone in a subject, said method comprising administering to said subject a therapeutically effective amount of a pharmaceutical composition comprising: (a) a polypeptide comprising the structure V-NP-W; and (b) a pharmaceutically acceptable excipient, wherein NP is a natriuretic peptide that is an agonist of natriuretic peptide receptor B (NPR-B); each of V and W is, independently, absent or is an amino acid sequence of at least one amino acid; and said NP comprises the amino acid sequence of any one of SEQ ID NOs: 17-29, 31-40, 42-94, 101-116, 119-122, 128-161, or 163-233, or V or W comprises the amino acid sequence of any one of SEQ ID NOs: 304-313, 322-333, or 337-389, thereby elongating bone in said subject.
 207. (canceled)
 208. A method of treating a disorder associated with overactivation of FGFR3, a bone or cartilage disorder, or a vascular smooth muscle disorder in a subject, said method comprising administering to said subject a therapeutically effective amount of a pharmaceutical composition comprising: (a) a polypeptide comprising the structure V-NP or NP-W; and (b) a pharmaceutically acceptable excipient, wherein NP is a natriuretic peptide that is an agonist of natriuretic peptide receptor B (NPR-B); and each of V and W comprises, independently, the amino acid sequence of any one of SEQ ID NOs: 304-313, 322-333, or 337-389, thereby treating said disorder associated with overactivation of FGFR3, bone or cartilage disorder, or vascular smooth muscle disorder in said subject.
 209. A method of elongating bone in a subject, said method comprising administering to said subject a therapeutically effective amount of a pharmaceutical composition comprising: (a) a polypeptide comprising the structure V-NP or NP-W; and (b) a pharmaceutically acceptable excipient, wherein NP is a natriuretic peptide that is an agonist of natriuretic peptide receptor B (NPR-B); and each of V and W comprises, independently, the amino acid sequence of any one of SEQ ID NOs: 304-313, 322-333, or 337-389, thereby elongating bone in said subject. 210.-252. (canceled) 